From the Research
Introduction to Abdominal Aortic Aneurysm (AAA)
Abdominal Aortic Aneurysm (AAA) is a complex condition characterized by the enlargement and weakening of the aorta, which may rupture and result in severe consequences, including death 1. Understanding the causes, risk factors, preventive measures, signs, symptoms, and treatment options for AAA is crucial for healthcare providers.
Causes and Risk Factors
The development of AAA is associated with various risk factors, including:
- Age greater than 60 years
- Tobacco use
- Male gender
- Caucasian race
- Family history of AAA
- Chronic pulmonary disease
- Hypertension
- Dyslipidemia
- Coronary artery disease 1, 2 These factors contribute to the weakening of the aortic wall, leading to the formation of an aneurysm.
Preventive Measures
Preventive measures for AAA include:
- Smoking cessation
- Blood pressure control
- Management of dyslipidemia and coronary artery disease
- Screening for AAA in high-risk individuals, such as men who have smoked at least 100 cigarettes and women with a family history of AAA disease 1 The Screening Abdominal Aortic Aneurysms Efficiently (SAAAVE) Act provides coverage for a one-time screening abdominal ultrasound at age 65 for men who have smoked at least 100 cigarettes and women who have family history of AAA disease.
Signs and Symptoms
AAA is often asymptomatic and detected incidentally on imaging studies, including abdominal ultrasound and computed tomographic angiography 1. However, symptoms may occur, including:
- Abdominal or back pain
- Thromboembolization
- Atheroembolization
- Aortic rupture
- Development of an arteriovenous or aortoenteric fistula
Treatment Options
Treatment options for AAA depend on the size and symptoms of the aneurysm. Medical management is recommended for asymptomatic patients with AAAs less than 5 cm in diameter and focuses on modifiable risk factors, including smoking cessation and blood pressure control 1. Intervention is indicated for patients with symptoms, rupture, rapid aneurysm growth, or presence of a fusiform aneurysm with maximum diameter of 5.5 cm or greater.
Surgical Repair
Surgical repair options include:
- Conventional open surgical repair
- Endovascular aortic stent graft repair 1, 3 Endovascular repair is a minimally invasive procedure that involves the placement of an endograft to exclude the aneurysm from blood circulation.
Endovascular Repair
Endovascular repair is associated with less severe hemodynamic changes, less blood transfusion, and shorter hospital stay compared to open surgical repair 3. However, there is a concern about the high incidence of endoleak, requiring secondary interventions, and in some cases, conversion to open surgical repair.
Differentials and Caveats
It is essential to consider the following differentials and caveats when managing AAA:
- Size and growth rate of the aneurysm
- Presence of symptoms
- Patient's risk profile and comorbidities
- Type of aneurysm (fusiform or saccular)
- Presence of endoleak or other complications after endovascular repair 1, 3, 2
Conclusion
Abdominal Aortic Aneurysm (AAA) is a complex condition that requires a comprehensive approach to management. Understanding the causes, risk factors, preventive measures, signs, symptoms, and treatment options for AAA is crucial for healthcare providers to provide optimal care for patients with this condition.