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Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is defined as a localized dilation of the artery that is 1.5 times the diameter of the normal segment. The most common location for an aortic aneurysm is the infrarenal segment where a diameter that exceeds 3 cm in diameter is considered aneurysmal. Duplex ultrasonography and spiral computerized tomography are the imaging modalities most commonly performed to detect the longitudinal and transverse diameter of the aorta. The prevalence of AAA may be increasing. Smoking, male gender, and increasing age are the most powerful predictors of AAA. Considering the higher prevalence of hypertension, it is surprising that the prevalence of AAA among African‐American men is 39% less than white men. The risk of rupture is independently associated with female gender, large initial aneurysm diameter, lower forced expiratory volume in the first second, current smoking, and higher mean blood pressure. Inflammation rather than atherosclerosis may be essential to the development of AAA. Treatment is directed at smoking cessation and control of blood pressure and lipids. Beta blockers (propranolol) have not been shown to modify aneurysm growth rates, but drop out rates in the studies have been high. Antibiotics do show a modest benefit. Surgery is generally performed when the aneurysm exceeds 5.5 cm in men. For women, an AAA size between 4.5 cm and 5.0 cm is recommended for elective repair.