{"id":12077,"date":"2021-04-28T04:32:23","date_gmt":"2021-04-28T04:32:23","guid":{"rendered":"https:\/\/lavascular.com\/?p=12077"},"modified":"2022-12-13T17:35:13","modified_gmt":"2022-12-13T17:35:13","slug":"abdominal-aortic-aneurysm","status":"publish","type":"post","link":"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/","title":{"rendered":"Abdominal Aortic Aneurysm"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_65 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<p class=\"ez-toc-title\">Table of Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-662836c11573f\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-662836c11573f\"  aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Introduction_to_AAA\" title=\"Introduction to AAA\">Introduction to AAA<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#What_is_the_Aorta\" title=\"What is the Aorta?\">What is the Aorta?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Abdominal_Aortic_Aneurysm_AAA\" title=\"Abdominal Aortic Aneurysm (AAA)\">Abdominal Aortic Aneurysm (AAA)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Why_is_aortic_aneurysm_dangerous\" title=\"Why is aortic aneurysm dangerous?\">Why is aortic aneurysm dangerous?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Types_of_aortic_aneurysms\" title=\"Types of aortic aneurysms\">Types of aortic aneurysms<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Suprarenal_Vs_Infrarenal_Aneurysm\" title=\"Suprarenal Vs Infrarenal Aneurysm\">Suprarenal Vs Infrarenal Aneurysm<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Aneurysm_Shapes_Morphology\" title=\"Aneurysm Shapes (Morphology):\">Aneurysm Shapes (Morphology):<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#What_is_a_dissecting_Aortic_Aneurysm\" title=\"What is a dissecting Aortic Aneurysm?\">What is a dissecting Aortic Aneurysm?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Causes_and_risk_factors_for_the_development_of_an_abdominal_aortic_aneurysm\" title=\"Causes and risk factors for the development of an abdominal aortic aneurysm\">Causes and risk factors for the development of an abdominal aortic aneurysm<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Risk_factors_for_aneurysm_development\" title=\"Risk factors for aneurysm development\">Risk factors for aneurysm development<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Symptoms_and_signs_of_an_abdominal_aortic_aneurysm\" title=\"Symptoms and signs of an abdominal aortic aneurysm\">Symptoms and signs of an abdominal aortic aneurysm<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Diagnosing_an_abdominal_aortic_aneurysms\" title=\"Diagnosing an abdominal aortic aneurysms\">Diagnosing an abdominal aortic aneurysms<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Aortic_aneurysm_treatment\" title=\"Aortic aneurysm treatment\">Aortic aneurysm treatment<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Management_of_Abdominal_Aortic_Aneurysms\" title=\"Management of Abdominal Aortic Aneurysms\">Management of Abdominal Aortic Aneurysms<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Ruptured_AAA\" title=\"Ruptured AAA\">Ruptured AAA<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Open_surgical_versus_endovascular_repair_of_ruptured_aneurysm\" title=\"Open surgical versus endovascular repair of ruptured aneurysm\">Open surgical versus endovascular repair of ruptured aneurysm<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Symptomatic_nonruptured_AAA\" title=\"Symptomatic (nonruptured) AAA\u00a0\">Symptomatic (nonruptured) AAA\u00a0<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Asymptomatic_aneurysm\" title=\"Asymptomatic aneurysm\u00a0\">Asymptomatic aneurysm\u00a0<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Medical_therapies\" title=\"Medical therapies\">Medical therapies<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/#Aneurysm_surveillance\" title=\"Aneurysm surveillance\u00a0\">Aneurysm surveillance\u00a0<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"Introduction_to_AAA\"><\/span><span style=\"font-weight: 400;\">Introduction to AAA<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">An abdominal aortic aneurysm (AAA) is a swelling or bulge in the abdominal aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs. An AAA can be life-threatening if it ruptures, which can cause internal bleeding and potentially lead to death. AAA is more common in older adults, especially those who smoke or have high <a href=\"https:\/\/lavascular.com\/hypertension\/\">blood pressure<\/a>, high cholesterol, or a family history of the condition. Symptoms of AAA may include abdominal or back pain, a pulsating feeling in the abdomen, and a feeling of pressure or fullness in the abdomen. AAA is often diagnosed with imaging tests such as ultrasound or CT scan. Treatment may involve medications, surgery, or other interventions to repair the aneurysm and prevent it from rupturing.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">An abdominal aortic aneurysm is the most common type of arterial aneurysm.\u00a0 Aortic aneurysm is a common condition that affects about 1 in 20 people (2 to 8%) in the developed world and is more common in men (4 to 8% in those older than 50) compared with women (1 to 1.3 percent) [<\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20630687\/\"><span style=\"font-weight: 400;\">ref<\/span><\/a><span style=\"font-weight: 400;\">].\u00a0 An aneurysm of the abdominal aorta\u00a0 is a local or diffuse expansion of the diameter of the abdominal aorta measuring greater than 3 cm or dilatation of the aortic diameter by greater than 50% of the normal vessel diameter. AAA account for 15,000 deaths per year in the United States.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Thinning of the wall and development of an aortic aneurysm is mainly acquired and is caused by atherosclerosis in about 95% of cases, other causes (nonspecific aortoarteritis, congenital causes, tuberculous, syphilitic, rheumatic aortic lesions ) accounts for only 5% of cases.\u00a0 In recent years, the number of traumatic aneurysms has increased, especially after car accidents. Among the most common causes of congenital causes of aneurysms of the abdominal aorta are fibromuscular dysplasia, Marfan syndrome.\u00a0 Although an Abdominal aortic aneurysm is often asymptomatic with an uncomplicated course a ruptured aneurysm is often fatal.\u00a0<\/span><\/p>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"What_is_the_Aorta\"><\/span><span style=\"font-weight: 400;\">What is the Aorta?<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The aorta is the largest artery in the human body. It carries oxygen-rich blood from the heart to the rest of the body. The aorta begins at the top of the left ventricle of the heart, and it descends through the chest and abdomen before dividing into smaller arteries that supply blood to the legs and other parts of the body. The aorta is made up of several layers of tissue, including the innermost endothelium, a layer of smooth muscle, and an outer layer of connective tissue. The aorta is essential for maintaining blood flow to the body&#8217;s tissues and organs, and any damage to the aorta can have serious consequences. Conditions that can affect the aorta include aneurysms, dissection, and stenosis.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The aorta is the largest artery in the human body. Blood enters the aorta after being pumped out from the left side of the heart, then, through numerous arterial branches, supplies oxygenated blood to all of the body&#8217;s organs. The aorta departs from the heart in an upward direction, forms an arch, then descends downward, passing through the chest cavity (thoracic aorta) and in the abdomen (abdominal aorta).\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The aortic wall consists of three layers: inner (intima), middle (media), outer (adventitia).<\/span><\/p>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"Abdominal_Aortic_Aneurysm_AAA\"><\/span>Abdominal Aortic Aneurysm (AAA)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">An aortic aneurysm is an enlargement of a portion of the aorta or a bulging of its wall.<\/span><span style=\"font-weight: 400;\"> An aneurysm of the abdominal aorta is defined as an increase in the aortic diameter by more than 50% in comparison with the normal vessel which results in bulging of the aortic wall. With the pressure of blood flowing through this vessel, the enlargement or bulging of the aorta can progress. The diameter of the normal aorta in the abdominal region is approximately 2 cm. However, at the site of the aneurysm, the aorta can be expanded to 7 cm or more.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0The most common type of aneurysm is an aortic aneurysm that originates in the abdomen (abdominal aortic aneurysm). Less commonly, the aorta that runs through the chest (thoracic aortic aneurysm) is affected.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The wall of the aorta in the area of \u200b\u200bthe aneurysm is much weaker than normal, so it may not withstand the pressure of the blood being pumped through it. This can lead to rupture of the aneurysm. The risk of this complication is directly correlated with the size of the aneurysm.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">5 years out from a AAA diagnosis, rupture occurs in approximately 2% of AAAs less than 4 cm in diameter and in more than 25% of AAAs larger than 5 cm.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In some cases, with a small size of the aneurysm, the operation may not be required urgently, but it may be necessary to undergo a followup examination every 6 months.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">This disease does not usually manifest itself with symptoms early on. With the progression of the disease and the absence of early treatment, aneurysm rupture can occur , and consequently, massive bleeding, which often is fatal. Timely referral to a specialist, high-quality consultative, diagnostic and surgical assistance can prevent the progression of the disease and ensure the prevention of a life-threatening complication &#8211; rupture of an aneurysm.<\/span><\/p>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"Why_is_aortic_aneurysm_dangerous\"><\/span>Why is aortic aneurysm dangerous?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">AAA are the cause of 15,000 deaths per year in the United States alone.\u00a0 AAA left unchecked will undergo continuous expansion resulting in increased risk of rupture. Most small aortic aneurysms increase in size by 2.5 mm per year; 4 mm per year is maximum normal growth<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The annual risk of rupture for abdominal aortic aneurysms are as follows<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">less than 5.5 cm: \u22641.0%<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">5.5 to 5.9 cm: 9.4%\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">6.0 to 6.9 cm: 10.2%<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u22657.0 cm: 32.5%.\u00a0<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">AAAs &gt;5.5 cm have an annual risk of rupture exceeding the elective 30-day operative mortality; hence, this has been the size criterion for elective repair in men.\u00a0 Abdominal aortic aneurysms that measure greater than 5 cm, have a 25% chance of rupture within 5 years.\u00a0 That means that\u00a0 25 out of 100 patients with aneurysms greater than 5cm will suffer an aortic rupture within 5 years of receiving the diagnosis. For aneurysms measuring less than 4cm in diameter the risk of rupture is approximately 2% up to 5 years post diagnosis.\u00a0 Unfortunately the risk of aortic rupture continues to increase as the size of the aneurysm increases.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The reason for concern is that a ruptured aneurysm can cause massive internal bleeding, which in turn can lead to shock or death.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Abdominal aortic aneurysms can cause other serious health problems. Blood clots (thrombi) are often formed in the aneurysm sac, or parts of the aneurysm.\u00a0 These can detach and move along the branches of the aorta and to other\u00a0 organs and extremities. If one of the blood vessels becomes blocked as a result of this, it can cause severe pain and lead to organ death or loss of a lower limb. Fortunately, if an aortic aneurysm is diagnosed early, treatment can be timely, safe, and effective.<\/span><\/p>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"Types_of_aortic_aneurysms\"><\/span>Types of aortic aneurysms<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A distinction is made between &#8220;true&#8221; and &#8220;false&#8221; aortic aneurysms. A true aneurysm develops as a result of the gradual weakening of all layers of the aortic wall and an outpouching. A false aneurysm also known as a pseudoaneurysm\u00a0 is usually the result of trauma and is a contained rupture of the aorta.\u00a0 A false aneurysm (Pseudoaneurysm) essentially<\/span><span style=\"font-weight: 400;\"> occurs when a blood vessel wall is injured and the leaking blood which collects in the surrounding tissue.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Aneurysms are further subdivided:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>by etiology<\/b><span style=\"font-weight: 400;\">\u00a0 &#8211; acquired (non-inflammatory or inflammatory) and congenital;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>by morphology<\/b><span style=\"font-weight: 400;\">\u00a0 &#8211; into false (of traumatic origin also known as pseudoaneurysm), true;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>in shape<\/b><span style=\"font-weight: 400;\">\u00a0 &#8211; Saccular, Fusiform;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>By clinical symptoms<\/b><span style=\"font-weight: 400;\">\u00a0 &#8211; Uncomplicated course, complicated;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>By location of aneurysm<\/b><span style=\"font-weight: 400;\">\u00a0 &#8211; This is the most commonly used as it has clinical implications.\u00a0 Aneurysm can be broken up into suprarenal and infrarenal aneurysms.<\/span><\/li>\n<\/ul>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"Suprarenal_Vs_Infrarenal_Aneurysm\"><\/span><span style=\"font-weight: 400;\">Suprarenal Vs Infrarenal Aneurysm<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li><span style=\"font-weight: 400;\">Suprarenal aneurysm \u2013 refers to an aneurysm which extends to the renal arteries and involves the origins of one or more visceral arteries (superior mesenteric artery or the celiac trunk) but generally does not extend into the chest.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Pararenal aneurysm \u2013 The renal arteries arise from the aneurysmal aorta, but the aorta above the renal arteries at the level of the superior mesenteric artery is not aneurysmal.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Juxtarenal aneurysm \u2013 The aneurysm originates just beyond the take off of the renal arteries. There is no segment of nonaneurysmal aorta distal to the renal arteries, but the aorta at the level of the renal arteries is not aneurysmal.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Infrarenal aneurysm \u2013 The aneurysm originates distal to the renal arteries. Do there is a segment of normal nonaneurysmal aorta beyond the renal arteries.\u00a0 This is the most common type accounting for 95% of cases.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The most common type of abdominal aortic aneurysm is the infrarenal abdominal aortic aneurysm type.\u00a0 These aneurysms generally start somewhere between the renal arteries and the inferior mesenteric artery.\u00a0 Suprarenal and pararenal aneurysms account for 5% of AAA cases.\u00a0 It should be noted that approximately 40% of abdominal aortic aneurysms are associated with iliac artery aneurysms.\u00a0<\/span><\/p>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"Aneurysm_Shapes_Morphology\"><\/span><span style=\"font-weight: 400;\">Aneurysm Shapes (Morphology)<\/span><b>:<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Saccular aneurysm &#8211; expansion of the aortic wall only on one side;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">fusiform (fusiform) aneurysm &#8211; expansion of the aneurysm cavity from all sides;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">mixed aneurysm &#8211; a combination of saccular and fusiform forms.<\/span><\/p>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"What_is_a_dissecting_Aortic_Aneurysm\"><\/span><span style=\"font-weight: 400;\">What is a dissecting Aortic Aneurysm?<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A dissecting aneurysm, forms as a result of rupture of the inner wall , followed by its dissection away from the remainder of the aortic wall layers and the formation of two channels one being the true original lumen and the second once being false channel for blood flow.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Depending on the location and length of the dissection, there are 3 classes of dissecting aortic aneurysm:<\/span><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\"> The dissection begins in the ascending part of the aorta, moves along the aortic arch (50%).<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> Dissection occurs only in the ascending part of the aorta (35%).<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> The dissection begins in the descending part of the aorta, moves down (more often) or up (less often) along the arch (15%).<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Depending on the age of the process, a dissecting aneurysm can be:<\/span><\/p>\n<p><span style=\"font-weight: 400;\">acute (1-2 days after the appearance of the endothelial defect);<\/span><\/p>\n<p><span style=\"font-weight: 400;\">subacute (2-4 weeks);<\/span><\/p>\n<p><span style=\"font-weight: 400;\">chronic (4-8 weeks or more, up to several years).<\/span><\/p>\n<h2 style=\"text-align: center;\"><span class=\"ez-toc-section\" id=\"Causes_and_risk_factors_for_the_development_of_an_abdominal_aortic_aneurysm\"><\/span><span style=\"font-weight: 400;\">Causes and risk factors for the development of an abdominal aortic aneurysm<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">There is generally no single distinct cause for the formation of an abdominal aortic aneurysm but rather several pathologies working in concert. Despite the multifactoral cause of aneurysms the most commonly attributed cause of aneurysm development is considered atherosclerosis. <a href=\"https:\/\/lavascular.com\/peripheral-artery-disease\/\">Atherosclerotic<\/a> aneurysms account for 96% of the total number of all aneurysms. In addition, aortic aneurysms can be both congenital (fibromuscular dysplasia, Erdheim&#8217;s cystic medionecrosis, Marfan syndrome, etc.), and acquired (inflammatory and non-inflammatory). Inflammation of the aorta occurs with various infections (syphilis, tuberculosis, salmonellosis, etc.) or as a result of an allergic-inflammatory process (nonspecific aortoarteritis). Non-inflammatory aneurysms most often develop with atherosclerotic aortic lesions. Less commonly, they are the result of trauma to its wall.<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Risk_factors_for_aneurysm_development\"><\/span>Risk factors for aneurysm development<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The risk factors associated with aneurysmal disease include:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Older age<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Male gender<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Cigarette smoking<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Caucasian race<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Atherosclerosis<\/span><\/li>\n<li><span style=\"font-weight: 400;\"><a href=\"https:\/\/lavascular.com\/hypertension\/\">Hypertension<\/a><\/span><\/li>\n<li><span style=\"font-weight: 400;\">Family history of AAA<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Other large artery aneurysms (eg, iliac, femoral, popliteal)\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">A decreased risk of AAA is associated with:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Female gender<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Non-Caucasian race<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Diabetes<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The presence of aneurysms in other family members is also a risk factor. It can indicate the role of a hereditary factor in the development of this disease;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Gender: men over the age of 60 (women have fewer abdominal aortic aneurysms).<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Symptoms_and_signs_of_an_abdominal_aortic_aneurysm\"><\/span><span style=\"font-weight: 400;\">Symptoms and signs of an abdominal aortic aneurysm<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In most patients, abdominal aortic aneurysms do not present with symptoms or clinical manifestations and are oftentimes incidental findings seen on imaging performed for other reasons.<\/span><\/p>\n<p><img decoding=\"async\" data-attachment-id=\"12250\" data-permalink=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/man-with-abdominal-pain\/\" data-orig-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/man-with-abdominal-pain.jpg?fit=267%2C300&amp;ssl=1\" data-orig-size=\"267,300\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Pouyan Golshani&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1625150887&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"man with abdominal pain\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/man-with-abdominal-pain.jpg?fit=267%2C300&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/man-with-abdominal-pain.jpg?fit=267%2C300&amp;ssl=1\" class=\"lazyload alignleft size-full wp-image-12250\" src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/man-with-abdominal-pain.jpg?resize=267%2C300&#038;ssl=1\" data-orig-src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/man-with-abdominal-pain.jpg?resize=267%2C300&#038;ssl=1\" alt=\"man with abdominal pain related to abdominal aortic aneurysm rupture\" width=\"267\" height=\"300\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27267%27%20height%3D%27300%27%20viewBox%3D%270%200%20267%20300%27%3E%3Crect%20width%3D%27267%27%20height%3D%27300%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/man-with-abdominal-pain.jpg?resize=200%2C225&amp;ssl=1 200w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/man-with-abdominal-pain.jpg?fit=267%2C300&amp;ssl=1 267w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 267px) 100vw, 267px\" data-recalc-dims=\"1\" \/><\/p>\n<p><span style=\"font-weight: 400;\">Patients with intact abdominal aortic aneurysm (AAA) may present with or without symptoms.<\/span><\/p>\n<p><b>Asymptomatic \u2013 <\/b><span style=\"font-weight: 400;\">The majority of patients are asymptomatic. A previously unknown AAA may also become apparent as a result of screening or be discovered incidentally on routine physical examination, on imaging studies performed for other indications, or in the course of evaluating other unrelated conditions. Asymptomatic AAAs are difficult to exclude based on physical examination alone in most patients, even when attempted by experienced examiners\/clinicians<\/span><span style=\"font-weight: 400;\">\u25cf<\/span><\/p>\n<p><b>Symptomatic but not ruptured \u2013 <\/b><span style=\"font-weight: 400;\">Symptomatic AAA refers to any of a number of symptoms that can be attributed to the aneurysm but are generally nonspecific. The development of symptoms may be a sign that AAA is rapidly enlarging, or has become large enough to compress surrounding structures, or is an inflammatory or infectious aneurysm. Patients with symptomatic AAA most commonly present with abdominal, back, or flank pain, which may or may not be associated with AAA rupture. AAA can also present with other clinical manifestations, such as limb ischemia (acute or chronic), or other systemic manifestations (fever, malaise) in those patient with infections. In patients with abdominal pain, rupture of the aneurysm must be excluded.\u00a0<\/span><\/p>\n<p><b>Symptomatic and ruptured \u2013 <\/b><span style=\"font-weight: 400;\">The clinical presentation of ruptured abdominal aortic aneurysm is variable with respect to symptoms and time course. The patient may or may not be aware of the diagnosis of AAA prior to their clinical manifestations of rupture. Only 20 to 30 percent of patients who present to an emergency department with rupture have a known history of AAA. The classic presentation of severe pain, hypotension, and a pulsatile abdominal mass occurs in approximately 50 percent of patients. Although the signs and symptoms of ruptured AAA may be obvious, some presentations make ruptured AAA difficult to recognize. Patients with rupture into the retroperitoneum may attribute their symptoms to other causes and delay seeking medical attention. Even after presenting to a physician, a misdiagnosis of ruptured AAA as renal colic, perforated viscus, diverticulitis, gastrointestinal hemorrhage, and ischemic bowel occurs approximately 30 percent of the time.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Diagnosing_an_abdominal_aortic_aneurysms\"><\/span><span style=\"font-weight: 400;\">Diagnosing an abdominal aortic aneurysms<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<div id=\"attachment_12251\" style=\"width: 305px\" class=\"wp-caption alignleft\"><img decoding=\"async\" aria-describedby=\"caption-attachment-12251\" data-attachment-id=\"12251\" data-permalink=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/ct-3d-reconstruction-of-aaa\/\" data-orig-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?fit=295%2C452&amp;ssl=1\" data-orig-size=\"295,452\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Pouyan Golshani&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1625152162&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"CT 3d reconstruction of AAA\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;3D reconstruction of a CT angiogram of the Abdomen\/Pelvis with an arrow showing an infra-renal abdominal aortic aneurysm&lt;\/p&gt;\n\" data-medium-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?fit=196%2C300&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?fit=295%2C452&amp;ssl=1\" class=\"lazyload size-full wp-image-12251\" src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?resize=295%2C452&#038;ssl=1\" data-orig-src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?resize=295%2C452&#038;ssl=1\" alt=\"CT 3d recon of AAA\" width=\"295\" height=\"452\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27295%27%20height%3D%27452%27%20viewBox%3D%270%200%20295%20452%27%3E%3Crect%20width%3D%27295%27%20height%3D%27452%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?resize=196%2C300&amp;ssl=1 196w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?resize=200%2C306&amp;ssl=1 200w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/CT-3d-reconstruction-of-AAA.jpg?fit=295%2C452&amp;ssl=1 295w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 295px) 100vw, 295px\" data-recalc-dims=\"1\" \/><p id=\"caption-attachment-12251\" class=\"wp-caption-text\">3D reconstruction of a CT angiogram of the Abdomen\/Pelvis with an arrow showing an infra-renal abdominal aortic aneurysm<\/p><\/div>\n<p><span style=\"font-weight: 400;\">Abdominal aortic aneurysms are often incidental and can most often be diagnosed by ultrasound of the abdomen and the abdominal aorta.\u00a0 Although this method is preferred in patients because of its lack of ionizing radiation and relative ease with which an ultrasound can be performed there are situations where CT or less often MRI is preferred.\u00a0 CT imaging can characterize aneurysms prior to surgery and also better help identify if aneurysms can undergo endovascular minimally invasive aneurysm repair versus open surgical repair.\u00a0 Additionally CT imaging is less operator dependent and therefore is more reproducible as well as sensitive and specific for aneurysms.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Computed tomography &#8211; CTA &#8211; CT Angiography which is a CT of the abdomen and pelvis with contrast timed for maximum opacification of the aorta is the most sensitive and specific study<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Magnetic resonance imaging &#8211; MRI can be performed with or without contrast (Time of flight imaging) however given that this exam takes significant time to perform and can sometimes miss other reasons for abdominal pain which can be identified with ultrasound and CT it is not the preferred imaging study.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ultrasound duplex scanning of the abdominal aorta is a great tool that allows for quick answers but can be dependent on the person performing the ultrasound (Operator dependent) .<\/span><\/p>\n<div id=\"attachment_12252\" style=\"width: 427px\" class=\"wp-caption alignleft\"><img decoding=\"async\" aria-describedby=\"caption-attachment-12252\" data-attachment-id=\"12252\" data-permalink=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/3d-recon-aaa-with-bone-oblique\/\" data-orig-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?fit=417%2C505&amp;ssl=1\" data-orig-size=\"417,505\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Pouyan Golshani&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1625154787&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"3d recon AAA with bone oblique\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?fit=248%2C300&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?fit=417%2C505&amp;ssl=1\" class=\"lazyload wp-image-12252 size-full\" src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?resize=417%2C505&#038;ssl=1\" data-orig-src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?resize=417%2C505&#038;ssl=1\" alt=\"AAA from CT just above the iliac artery bifurcation\" width=\"417\" height=\"505\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27417%27%20height%3D%27505%27%20viewBox%3D%270%200%20417%20505%27%3E%3Crect%20width%3D%27417%27%20height%3D%27505%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?resize=200%2C242&amp;ssl=1 200w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?resize=248%2C300&amp;ssl=1 248w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?resize=400%2C484&amp;ssl=1 400w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-AAA-with-bone-oblique.jpg?fit=417%2C505&amp;ssl=1 417w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 417px) 100vw, 417px\" data-recalc-dims=\"1\" \/><p id=\"caption-attachment-12252\" class=\"wp-caption-text\">3D recon from a CT showing an AAA above the iliac artery bifurcation<\/p><\/div>\n<div id=\"attachment_12253\" style=\"width: 531px\" class=\"wp-caption alignleft\"><img decoding=\"async\" aria-describedby=\"caption-attachment-12253\" data-attachment-id=\"12253\" data-permalink=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/ultrasound-of-aaa\/\" data-orig-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?fit=521%2C469&amp;ssl=1\" data-orig-size=\"521,469\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Pouyan Golshani&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1625154320&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"ultrasound of AAA\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?fit=300%2C270&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?fit=521%2C469&amp;ssl=1\" class=\"lazyload wp-image-12253 size-full\" src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?resize=521%2C469&#038;ssl=1\" data-orig-src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?resize=521%2C469&#038;ssl=1\" alt=\"ultrasound showing a AAA with mural thrombus\" width=\"521\" height=\"469\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27521%27%20height%3D%27469%27%20viewBox%3D%270%200%20521%20469%27%3E%3Crect%20width%3D%27521%27%20height%3D%27469%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?resize=200%2C180&amp;ssl=1 200w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?resize=300%2C270&amp;ssl=1 300w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?resize=400%2C360&amp;ssl=1 400w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/ultrasound-of-AAA.jpg?fit=521%2C469&amp;ssl=1 521w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 521px) 100vw, 521px\" data-recalc-dims=\"1\" \/><p id=\"caption-attachment-12253\" class=\"wp-caption-text\">Transverse ultrasound of an AAA with mural thrombus<\/p><\/div>\n<div id=\"attachment_12254\" style=\"width: 599px\" class=\"wp-caption alignleft\"><img decoding=\"async\" aria-describedby=\"caption-attachment-12254\" data-attachment-id=\"12254\" data-permalink=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/3d-recon-of-aaa\/\" data-orig-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?fit=589%2C467&amp;ssl=1\" data-orig-size=\"589,467\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Pouyan Golshani&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1625154729&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"3d recon of AAA\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?fit=300%2C238&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?fit=589%2C467&amp;ssl=1\" class=\"lazyload wp-image-12254 size-full\" src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?resize=589%2C467&#038;ssl=1\" data-orig-src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?resize=589%2C467&#038;ssl=1\" alt=\"3d recons of AAA\" width=\"589\" height=\"467\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27589%27%20height%3D%27467%27%20viewBox%3D%270%200%20589%20467%27%3E%3Crect%20width%3D%27589%27%20height%3D%27467%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?resize=200%2C159&amp;ssl=1 200w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?resize=300%2C238&amp;ssl=1 300w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?resize=400%2C317&amp;ssl=1 400w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-AAA.jpg?fit=589%2C467&amp;ssl=1 589w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 589px) 100vw, 589px\" data-recalc-dims=\"1\" \/><p id=\"caption-attachment-12254\" class=\"wp-caption-text\">A) demonstrates an infra-renal AAA B) shows a bilobed AAA originating below the level of the renal arteries<\/p><\/div>\n<div id=\"attachment_12255\" style=\"width: 405px\" class=\"wp-caption alignleft\"><img decoding=\"async\" aria-describedby=\"caption-attachment-12255\" data-attachment-id=\"12255\" data-permalink=\"https:\/\/lavascular.com\/abdominal-aortic-aneurysm\/3d-recon-of-aaa-with-bone\/\" data-orig-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?fit=395%2C542&amp;ssl=1\" data-orig-size=\"395,542\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Pouyan Golshani&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1625154756&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"3d recon of aaa with bone\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Image showing 3D recon of an AAA resulting in angulation and arising close to the renal arteries which precludes endovascular treatment&lt;\/p&gt;\n\" data-medium-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?fit=219%2C300&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?fit=395%2C542&amp;ssl=1\" class=\"lazyload size-full wp-image-12255\" src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?resize=395%2C542&#038;ssl=1\" data-orig-src=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?resize=395%2C542&#038;ssl=1\" alt=\"3D recon of abdominal aortic aneurysm anterior\" width=\"395\" height=\"542\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27395%27%20height%3D%27542%27%20viewBox%3D%270%200%20395%20542%27%3E%3Crect%20width%3D%27395%27%20height%3D%27542%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?resize=200%2C274&amp;ssl=1 200w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?resize=219%2C300&amp;ssl=1 219w, https:\/\/i0.wp.com\/lavascular.com\/wp-content\/uploads\/3d-recon-of-aaa-with-bone.jpg?fit=395%2C542&amp;ssl=1 395w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 395px) 100vw, 395px\" data-recalc-dims=\"1\" \/><p id=\"caption-attachment-12255\" class=\"wp-caption-text\">Image showing 3D recon of an AAA resulting in angulation and arising close to the renal arteries which precludes endovascular treatment<\/p><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Aortic_aneurysm_treatment\"><\/span>Aortic aneurysm treatment<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">There are several treatments for aortic aneurysm. It is important to know the advantages and disadvantages of each of these techniques. Approaches to the treatment of abdominal aortic aneurysms:<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Management_of_Abdominal_Aortic_Aneurysms\"><\/span>Management of Abdominal Aortic Aneurysms<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Abdominal aortic aneurysms (AAAs) are managed according to their diameter and the presence or absence of symptoms. Under most circumstances, patients with symptoms that cannot be definitively attributed to another etiology should be admitted for observation and further vascular evaluation. Asymptomatic aneurysms are evaluated on an outpatient basis, unless they are very large.\u00a0<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Ruptured_AAA\"><\/span><b>Ruptured AAA<\/b><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Repair of ruptured abdominal aortic aneurysm (AAA) can be offered to most patients, and the timing of the initial evaluation and management of the patient is guided by the hemodynamic status of the patient. The hemodynamically unstable patient (persistent in spite of resuscitation) with known AAA who presents with classic symptoms\/signs of rupture (hypotension, flank\/back pain, pulsatile mass) should be taken emergently to the operating room for immediate control of hemorrhage, resuscitation, and repair of the aneurysm. Imaging confirmation of the presence of AAA in hemodynamically unstable patients suspected but not known to have the disease is ideal prior to intervention but is not required. Preoperative management of hemodynamically unstable patients, including the concept of &#8220;hypotensive hemostasis,&#8221; is an area of active investigation. However, in most circumstances, volume resuscitation should be provided to the least amount necessary to maintain mentation and stabilize blood pressure and pulse rate.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For patients with suspected ruptured AAA who are hemodynamically stable, abdominal imaging (preferably computed tomographic [CT] aortography) should be performed urgently to confirm the rupture prior to repair, rule out other potential etiologies as a cause of abdominal pain and hypotension, and determine if an endovascular repair is feasible.<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Open_surgical_versus_endovascular_repair_of_ruptured_aneurysm\"><\/span><b>Open surgical versus endovascular repair of ruptured aneurysm<\/b><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Both open and endovascular techniques can be successfully employed in the treatment of ruptured AAA. Endovascular repair of ruptured AAA may have some advantages over open repair; however, it is not universally available, and the selection of technique is best determined by the available surgical team. Open surgical or endovascular repair of ruptured AAA is accomplished in a manner that is similar to elective repair, with modifications for aortic hemorrhage control, and anticoagulation. Conversion rates from endovascular to open repair for ruptured AAA may be higher compared with elective repair because of unanticipated anatomic features or device-related issues.\u00a0<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Symptomatic_nonruptured_AAA\"><\/span><b>Symptomatic (nonruptured) AAA<\/b><span style=\"font-weight: 400;\">\u00a0<\/span><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\"> Aneurysm repair is indicated for patients with symptoms (abdominal\/back\/flank pain, thromboembolism) that cannot unequivocally be attributed to another etiology, regardless of aneurysm diameter. For patients with symptomatic AAA, the first priority is to determine whether there is any immediate concern that the aneurysm has ruptured or is at high risk for impending rupture, which may be suggested by clinical symptoms or signs, or certain radiologic features (eg, broken calcification, asymmetry) that may indicate instability of the aneurysm.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In the absence of overt rupture, patients with AAA who are thought to be symptomatic or who have possible signs of impending rupture should be admitted for observation and further evaluation. If the patient is a candidate, repair should be accomplished during the same hospitalization.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If the patient is a candidate for repair, a determination needs to be made about whether an open surgical or endovascular approach is more appropriate, primarily based upon an anatomic assessment of aortoiliac anatomy.\u00a0<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Asymptomatic_aneurysm\"><\/span>Asymptomatic aneurysm<span style=\"font-weight: 400;\">\u00a0<\/span><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\"> The management of asymptomatic AAA is based upon an assessment of the patient&#8217;s risk for rupture, compared with the expected risk of perioperative morbidity and mortality associated with repair. When the risk of rupture exceeds the risk of repair, repair is recommended. Conversely, if the risk of repair is greater than the risk of rupture, conservative management and surveillance is recommended.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The assessment of rupture risk depends primarily upon the diameter of the aneurysm at diagnosis and the patient&#8217;s medical comorbidities. The annual risk of rupture has been found in randomized trials to be similar to, or lower than, the risk of repair in patients with small- or medium-sized aneurysms (&lt;5.5 cm in diameter). This diameter threshold for <a href=\"https:\/\/lavascular.com\/aortic-aneurysm-treatment\/\">AAA repair<\/a> is not absolute and may depend on the patient&#8217;s stature and location of the aneurysm. Other factors that need to be taken into account include the patient&#8217;s age and gender, faster expansion rates, and the presence of other peripheral aneurysms.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Patients who are not candidates for repair or refuse repair should create an advanced directive detailing their wishes in the event of rupture. Family members should be made aware of these wishes, given that the patient may not be able to report these wishes at the time of aneurysm rupture.\u00a0<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Medical_therapies\"><\/span>Medical therapies<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">During the period of observation (watchful waiting), medical therapies are aimed at reducing the rate of aortic expansion and morbidity and mortality from cardiovascular disease. However, no medical therapy other than smoking cessation has proven effective at reducing the rate of AAA enlargement and possibly, by extrapolation, risk for rupture.\u00a0<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Aneurysm_surveillance\"><\/span>Aneurysm surveillance<span style=\"font-weight: 400;\">\u00a0<\/span><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\"> During the period of observation, ultrasound surveillance is routinely performed on a schedule that depends primarily upon the diameter of the aneurysm. We generally obtain annual ultrasound; however, a more frequent interval (eg, every six months) may be used depending upon other characteristics of the aneurysm or patient-related factors. Factors that influence the aneurysm surveillance interval are discussed separately. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction to AAA An abdominal aortic aneurysm (AAA) is a swelling or bulge in the abdominal aorta, the large blood vessel that supplies blood to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":12136,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_themeisle_gutenberg_block_has_review":false,"jetpack_post_was_ever_published":false,"_ti_tpc_template_sync":false,"_ti_tpc_template_id":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[28,34],"tags":[],"jetpack_publicize_connections":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Abdominal Aortic Aneurysm - LA Vascular<\/title>\n<meta name=\"description\" content=\"Abdominal Aortic Aneurysm - Diseases &amp; 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