Outpatient surveillance of abdominal aortic aneurysm

Rupture of abdominal aortic aneurysm (AAA) continues to be an important treatable cause of death. It is estimated that 28,000 new patients are diagnosed each year with AAA and 5,000 patients present with rupture. Health care costs escalate enormously when surgical treatment is delayed until the time of aneurysm rupture, the hospitalization is lengthy, and mortality rates are unacceptably high. Increasing physician awareness of the need for early detection and elective aneurysm repair before rupture are of clear benefit in reducing mortality from this disease. Primary care physicians and other specialists are often the first to discover abdominal aortic aneurysms. The task becomes how to minimize the risk of AAA rupture while avoiding unnecessary surgery in patients who would have died from other causes before AAA rupture. Recent clarification of several issues, including size of the normal adult abdominal aorta, definition of aneurysm, natural history, familial tendencies, risk factors for rupture, and surgical outcome have heightened the responsibility we have to the general population in knowing who to screen and who needs surgical treatment when the screening studies are positive.