Aneurysms: abdominal aortic aneurysms

Ruptured abdominal aortic aneurysms (AAAs) cause approximately 16,000 deaths per year in the United States. Smoking, male sex, advanced age, hypertension, and family history are risk factors. AAAs suspected on physical examination should be evaluated with ultrasonography. In addition, ultrasonography screening for AAA is recommend for men ages 65 to 75 years with smoking histories. For men ages 65 to 75 years who have never smoked, screening should be performed selectively, such as for those with family histories of AAA. Screening women currently is not recommended, regardless of smoking status. Surgical repair is indicated for men with AAA diameters of 5.5 cm or greater. The common practice for women is to repair AAAs with diameters of 5.0 cm or greater. For patients with smaller AAAs, cardiac risk factor management is recommended along with interval ultrasonography monitoring. Surgery is indicated if monitoring shows that an AAA is enlarging (by 1 cm or more per year) or reaches the noted limits. Repair of AAA (ruptured or unruptured) is accomplished with open surgery or endovascular procedures (eg, transcatheter placement of a stent graft). Endovascular procedures are now used more frequently than open surgery and have similar outcomes.