Abdominal Aortic Aneurysm

Pathway

Images

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1a		Abdominal Aortic and Right Iliac Artery Aneurysms Image 1a and 1b (Computed Tomography): Axial and reconstructed images of an abdominal aortic aneurysm. There is also a right iliac artery aneurysm which is partially occluded by thrombus.
1b
2		Tortuous infra-renal abdominal aortic aneurysm with thrombosis of the rest of the sac.
3		Infra-renal abdominal aortic aneurysm with involvement of both common and internal iliac arteries.
4		A large abdominal aortic aneurysm is seen which has ruptured with intraluminal developing thrombus formation and intra and retroperitoneal haemorrhage.

Teaching Points

Teaching Points

• Physical examination has a moderate sensitivity for the detection of AAA
• Ultrasound is highly accurate in detecting the presence or absence of AAA
  • Depending on the size of the aneurysm, further management is based on repeat ultrasounds at variable intervals or referral for surgical intervention (AAA >5cm)
• CT angiography allows evaluation of the anatomy of the abdominal aortic aneurysm and associated structures prior to elective surgical repair

References

References

Date of literature search: August 2015

The search methodology is available on request. Email

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

1. Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011;41 Suppl 1:S1-s58. (Guidelines). View the reference
2. RESCAN Collaborators, Bown MJ, Sweeting MJ, Brown LC, Powell JT, Thompson SG. Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis. JAMA. 2013;309(8):806-13. (Level I evidence). View the reference
3. Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation. 2004;110(1):16-21. (Level II evidence). View the reference
4. Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD, Jr., Blebea J, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002;287(22):2968-72. (Level II evidence). View the reference
5. Powell JT, Gotensparre SM, Sweeting MJ, Brown LC, Fowkes FG, Thompson SG. Rupture rates of small abdominal aortic aneurysms: a systematic review of the literature. Eur J Vasc Endovasc Surg. 2011;41(1):2-10. (Level II evidence). View the reference
6. The United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1445-52. (Level I evidence). View the reference
7. Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1437-44. (Level I evidence). View the reference
8. Pleumeekers HJ, Hoes AW, Mulder PG, van der Does E, Hofman A, Lameris JS, et al. Differences in observer variability of ultrasound measurements of the proximal and distal abdominal aorta. J Med Screen. 1998;5(2):104-8. (Level III evidence). View the reference
9. Norman PE, Powell JT. Abdominal aortic aneurysm: the prognosis in women is worse than in men. Circulation. 2007;115(22):2865-9. (Review article). View the reference
10. Powell JT, Sweeting MJ, Brown LC, Gotensparre SM, Fowkes FG, Thompson SG. Systematic review and meta-analysis of growth rates of small abdominal aortic aneurysms. Br J Surg. 2011;98(5):609-18. (Level II evidence). View the reference
11. Wild JB, Stather PW, Biancari F, Choke EC, Earnshaw JJ, Grant SW, et al. A multicentre observational study of the outcomes of screening detected sub-aneurysmal aortic dilatation. Eur J Vasc Endovasc Surg. 2013;45(2):128-34. (Level III evidence). View the reference
12. Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB, Haas MA. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med. 2000;160(6):833-6. (Level III evidence). View the reference
13. Kuhn M, Bonnin RL, Davey MJ, Rowland JL, Langlois SL. Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate, and advantageous. Ann Emerg Med. 2000;36(3):219-23. (Level II evidence). View the reference
14. Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005;142(3):203-11. (Level I evidence). View the reference
15. Burrill J, Dabbagh Z, Gollub F, Hamady M. Multidetector computed tomographic angiography of the cardiovascular system. Postgraduate Medical Journal. 2007;83(985):698-704. (Review article). View the reference
16. Hellinger JC. Endovascular repair of thoracic and abdominal aortic aneurysms: pre- and postprocedural imaging. Tech Vasc Interv Radiol. 2005;8(1):2-15. (Review article). View the reference
17. Budovec JJ, Pollema M, Grogan M. Update on multidetector computed tomography angiography of the abdominal aorta. Radiol Clin North Am. 2010;48(2):283-309, viii. (Review article). View the reference

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