www.fgks.org   »   [go: up one dir, main page]
brand logo

KABIUL HAQUE, MD, MPH, AND PEEYUSH BHARGAVA, MD, MBA

Am Fam Physician. 2022;106(2):165-172

 This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Abdominal aortic aneurysm is a pathologic condition with progressive abdominal aortic dilatation of 3.0 cm or more that predisposes the abdominal aorta to rupture. Most abdominal aortic aneurysms are asymptomatic until they rupture, although some are detected when an imaging study is performed for other reasons. The risk factors for abdominal aortic aneurysm include hypertension, coronary artery disease, tobacco use, male sex, a family history of abdominal aortic aneurysm, age older than 65 years, and peripheral artery disease. Abdominal ultrasonography is the preferred modality to screen for abdominal aortic aneurysm because of its cost-effectiveness and lack of exposure to ionizing radiation. Abdominal aortic aneurysm can be managed medically or surgically, depending on the patient's symptoms and the size and growth rate of the aneurysm. Medical management is appropriate for asymptomatic patients and smaller aneurysms and includes tobacco cessation and therapy for cardiovascular risk reduction. Surgical management, which includes open and endovascular aneurysm repair, is indicated when the aneurysm diameter is 5.5 cm or larger in men and 5.0 cm or larger in women. Surveillance of abdominal aortic aneurysm depends on the size and growth rate of the aneurysm. The most serious complication of abdominal aortic aneurysm is rupture, which requires emergent surgical intervention. The U.S. Preventive Services Task Force recommends that men with a history of smoking who are 65 to 75 years of age should undergo one-time abdominal aortic aneurysm screening with ultrasonography.

Already a member/subscriber?  Log In

Subscribe

From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available

Article Only

$25.95
  • Immediate, unlimited access to just this article
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

  1. Kumar Y, Hooda K, Li S, et al. Abdominal aortic aneurysm: pictorial review of common appearances and complications. Ann Transl Med. 2017;5(12):256.

  2. Saw ST, Leong BDK, Aziz DAA. Early detection of undiagnosed abdominal aortic aneurysm and sub-aneurysmal aortic dilatations in patients with high-risk coronary artery disease: the value of targetted screening programme. Vasc Health Risk Manag. 2020;16:215-229.

  3. Zucker EJ, Prabhakar AM. Abdominal aortic aneurysm screening: concepts and controversies. Cardiovasc Diagn Ther. 2018;8(suppl 1):S108-S117.

  4. Oliver-Williams C, Sweeting MJ, Turton G, et al.; Gloucestershire and Swindon Abdominal Aortic Aneurysm Screening Programme. Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme. Br J Surg. 2018;105(1):68-74.

  5. Malayala SV, Raza A, Vanaparthy R. Gender-based differences in abdominal aortic aneurysm rupture: a retrospective study [published correction appears in J Clin Med Res. 2021; 13(7): 412]. J Clin Med Res. 2020;12(12):794-802.

  6. Brown PM, Zelt DT, Sobolev B. The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg. 2003;37(2):280-284.

  7. Norman PE, Curci JA. Understanding the effects of tobacco smoke on the pathogenesis of aortic aneurysm. Arterioscler Thromb Vasc Biol. 2013;33(7):1473-1477.

  8. Owens DK, Davidson KW, Krist AH, et al.; US Preventive Services Task Force. Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA. 2019;322(22):2211-2218.

  9. Daugherty A, Cassis LA. Mechanisms of abdominal aortic aneurysm formation. Curr Atheroscler Rep. 2002;4(3):222-227.

  10. Lo RC, Schermerhorn ML. Abdominal aortic aneurysms in women. J Vasc Surg. 2016;63(3):839-844.

  11. Davies MJ. Aortic aneurysm formation: lessons from human studies and experimental models. Circulation. 1998;98(3):193-195.

  12. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2.

  13. Takagi H, Umemoto T ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Negative association of diabetes with rupture of abdominal aortic aneurysm. Diab Vasc Dis Res. 2016;13(5):341-347.

  14. Lederle FA, Simel DL. The rational clinical examination. Does this patient have abdominal aortic aneurysm?. JAMA. 1999;281(1):77-82.

  15. Tuveson V, Löfdahl HE, Hultgren R. Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms. Vasc Med. 2016;21(4):369-375.

  16. Su CY, Lee CW, Huang CY. Ruptured abdominal aortic aneurysm presented as Cullen's sign and Grey Turner's sign. Anatol J Cardiol. 2020;23(3):E7-E8.

  17. Marston WA, Ahlquist R, Johnson G, et al. Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg. 1992;16(1):17-22.

  18. Harris LM, Faggioli GL, Fiedler R, et al. Ruptured abdominal aortic aneurysms: factors affecting mortality rates. J Vasc Surg. 1991;14(6):812-818 , discussion 819–820.

  19. Bird AN, Davis AM. Screening for abdominal aortic aneurysm. JAMA. 2015;313(11):1156-1157.

  20. Scaife M, Giannakopoulos T, Al-Khoury GE, et al. Contemporary applications of ultrasound in abdominal aortic aneurysm management. Front Surg. 2016;3:29.

  21. Uppot RN. Impact of obesity on radiology. Radiol Clin North Am. 2007;45(2):231-246.

  22. Blois B. Office-based ultrasound screening for abdominal aortic aneurysm. Can Fam Physician. 2012;58(3):e172-e178.

  23. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47(6):1239-1312.

  24. Brady AR, Thompson SG, Fowkes FGR, et al.; UK Small Aneurysm Trial Participants. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation. 2004;110(1):16-21.

  25. Brewster DC, Cronenwett JL, Hallett JW, et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003;37(5):1106-1117.

  26. Kent KC, Zwolak RM, Jaff MR, et al. Screening for abdominal aortic aneurysm: a consensus statement. J Vasc Surg. 2004;39(1):267-269.

  27. Kent KC, Zwolak RM, Egorova NN, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010;52(3):539-548.

  28. Golledge J, Powell JT. Medical management of abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2007;34(3):267-273.

  29. Baxter BT, Matsumura J, Curci JA, et al.; N-TA3CT Investigators. Effect of doxycycline on aneurysm growth among patients with small infrarenal abdominal aortic aneurysms: a randomized clinical trial. JAMA. 2020;323(20):2029-2038.

  30. Vammen S, Lindholt JS, Ostergaard L, et al. Randomized double-blind controlled trial of roxithromycin for prevention of abdominal aortic aneurysm expansion [published correction appears in Br J Surg. 2002; 89(1): 120–121]. Br J Surg. 2001;88(8):1066-1072.

  31. Wanhainen A, Verzini F, Van Herzeele I, et al. Editor's Choice-European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms [published correction appears in Eur J Vasc Endovasc Surg. 2020; 59(3): 494]. Eur J Vasc Endovasc Surg. 2019;57(1):8-93.

  32. Kertai MD, Boersma E, Westerhout CM, et al. A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg. 2004;28(4):343-352.

  33. Erbel R, Aboyans V, Boileau C, et al.; ESC Committee for Practice Guidelines. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) [published correction appears in Eur Heart J. 2015; 36(41): 2779]. Eur Heart J. 2014;35(41):2873-2926.

  34. Salata K, Syed M, Hussain MA, et al. Statins reduce abdominal aortic aneurysm growth, rupture, and perioperative mortality: a systematic review and meta-analysis. J Am Heart Assoc. 2018;7(19):e008657.

  35. Reimerink JJ, van der Laan MJ, Koelemay MJ, et al. Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm. Br J Surg. 2013;100(11):1405-1413.

  36. Swerdlow NJ, Wu WW, Schermerhorn ML. Open and endovascular management of aortic aneurysms. Circ Res. 2019;124(4):647-661.

  37. Davidovic LB, Markovic M, Kostic D, et al. Open repair of ruptured abdominal aortic aneurysm with associated horseshoe kidney. Int Angiol. 2018;37(6):471-478.

  38. Hertzer NR, Mascha EJ, Karafa MT, et al. Open infrarenal abdominal aortic aneurysm repair: the Cleveland Clinic experience from 1989 to 1998. J Vasc Surg. 2002;35(6):1145-1154.

  39. Reite A, Søreide K, Kvaløy JT, et al. Long-term outcomes after open repair for ruptured abdominal aortic aneurysm. World J Surg. 2020;44(6):2020-2027.

  40. Reise JA, Sheldon H, Earnshaw J, et al. Patient preference for surgical method of abdominal aortic aneurysm repair: postal survey. Eur J Vasc Endovasc Surg. 2010;39(1):55-61.

  41. Patel R, Sweeting MJ, Powell JT, et al.; EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366-2374.

  42. Sweeting MJ, Patel R, Powell JT, et al.; EVAR Trial Investigators. Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: very long-term follow-up in the EVAR-2 randomized controlled trial. Ann Surg. 2017;266(5):713-719.

  43. Lederle FA, Freischlag JA, Kyriakides TC, et al.; Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Outcomes following endovascular vs. open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302(14):1535-1542.

  44. Moll FL, Powell JT, Fraedrich G, et al.; European Society for Vascular Surgery. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg. 2011;41(suppl 1):S1-S58.

  45. Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician. 2015;91(8):538-543.

Continue Reading

More in AFP

More in PubMed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.