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Feature Article

Abdominal aortic aneurysms. Part 1: Assessment and surveillance

David Goh, Jason Chuen

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Abstract

Abdominal aortic aneurysms are often asymptomatic, with common risk factors including older age, male gender, smoking and hypertension. It is essential to identify, monitor and repair these aneurysms before they rupture. This first part of a two-part article discusses assessment, surveillance protocols, screening and indications for prophylactic repair of abdominal aortic aneurysms.

Key Points

  • Aortic aneurysms are a common incidental finding in elderly patients and are often asymptomatic.
  • Aortic aneurysms are most commonly found in the abdominal aorta, but are also found in the thoracic aorta, aortic arch and ascending aorta.
  • Common risk factors for abdominal aortic aneurysms (AAAs) include older age, male gender, smoking and hypertension.
  • There is a strong familial prevalence of AAA and screening should be considered in patients from 50 years of age with a familial history of AAA.
  • AAA screening is currently not routine in Australia, but has been shown to reduce mortality in selected groups (e.g. men aged 65 to 75 years who smoke).
  • Ultrasound is a useful noninvasive investigation for initial diagnosis and surveillance of AAA, whereas computed tomography is useful for anatomical detail and decision-making for operative intervention.
  • After a diagnosis of AAA has been made, the patient should be placed on a surveillance program to monitor the size.
  • Once an AAA reaches 5.5 cm in men or 5.0 cm in women, the risk of rupture is generally greater than the risk of operative morbidity and mortality. Rapid growth of an AAA (>1.0 cm per year) or local symptoms are indications for consideration of repair.

    Picture credit: © Cultura/Callista Images/Diomedia.com

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