From the Guidelines
Abdominal aortic aneurysm (AAA) should be treated with elective repair if the diameter is ≥55 mm in men or ≥50 mm in women, as recommended by the 2024 ESC guidelines 1. The diagnosis of AAA typically involves imaging studies such as ultrasound, CT, or MRI to determine the size and shape of the aneurysm.
- Key factors to consider in the diagnosis and treatment of AAA include:
- Aneurysm size and growth rate
- Patient anatomy and suitability for endovascular repair
- Life expectancy and surgical risk
- Presence of concomitant aneurysms or other vascular diseases In patients with ruptured AAA and suitable anatomy, endovascular repair is recommended over open repair to reduce peri-operative morbidity and mortality 1. For patients with unruptured AAA, EVAR should be considered as the preferred therapy, based on shared decision-making, in those with suitable anatomy and reasonable life expectancy (>2 years) 1. It is also important to consider the patient's overall health and risk factors, such as smoking, hypertension, and family history, when making treatment decisions.
- Pre-operative evaluation should include:
- Assessment of the femoro-popliteal segment using DUS to detect concomitant aneurysms 1
- Evaluation of life expectancy and surgical risk
- Discussion of the risks and benefits of different treatment options, including EVAR and open repair In patients with limited life expectancy (<2 years), elective AAA repair is not recommended 1.
From the Research
Diagnosis of Abdominal Aortic Aneurysm (AAA)
- An abdominal aortic aneurysm (AAA) is usually detected on routine examination as a palpable, pulsatile, and non-tender mass 2
- Abdominal radiography may show the calcified outline of the aneurysms; however, about 25% of aneurysms are not calcified and cannot be visualized by plain x-ray 2
- An abdominal ultrasound provides more accurate detection, can delineate the traverse and longitudinal dimensions of the aneurysm, and is useful for serial documentation of aneurysm size 2
- Computed tomography and magnetic resonance have also been used for follow-up of aortic aneurysms 2
- Abdominal aortography remains the gold standard to evaluate patients with aneurysms for surgery 2
Treatment of Abdominal Aortic Aneurysm (AAA)
- Open surgical repair of AAA is still the gold standard 2
- Endovascular repair of AAA is a procedure for repairing abdominal aortic aneurysms from within the blood vessel without open surgery 2
- Treatment with statins has been shown to reduce cardiovascular mortality in patients with AAA, and also slows the rate of AAA growth 3
- Use of beta-blockers, ACE inhibitors and AT1-receptor antagonists does not affect AAA growth but may be indicated for comorbidities 3
- Patients with an AAA should undergo intensive risk factor modification including cessation of smoking, treatment of hypertension, statins, beta-adrenergic blocking drugs, and angiotensin-converting enzyme inhibitors 4
- The choice of open surgery vs endovascular repair depends on the patient's condition, preference, and life expectancy, and the surgeon's experience 5
Management Options for Asymptomatic AAA
- Reduction of risk factors such as smoking, hypertension and dyslipidemia 6
- Medical therapy with beta-blockers 6
- Watchful waiting 6
- Endovascular stenting 6
- Surgical repair depending on the size and expansion rate of the aneurysm and underlying comorbidities 6
Screening for AAA
- Abdominal ultrasonography is considered the screening modality of choice for detecting AAAs because of its high sensitivity and specificity, as well as its safety and relatively lower cost 6
- The United States Preventive Services Task Force recommended that men between the age of 65 to 75 years who have ever smoked should be screened at least once for AAAs by abdominal ultrasonography 6