• Most aortic aneurysms are asymptomatic until rupture, which is catastrophic
• Aneurysms measuring 5 cm are palpable in 80% of patients
• Back or abdominal pain with aneurysmal tenderness may precede rupture
• Excruciating abdominal pain that radiates to the back
• The aorta of a healthy young man measures approximately 2 cm
• An aneurysm is considered present when the aortic diameter exceeds 3 cm
• Aneurysms rarely cause rupture until diameter exceeds 5 cm
• 90% of abdominal atherosclerotic aneurysms originate below the renal arteries
• Aortic bifurcation is usually involved
• Common iliac arteries are often involved
• Most asymptomatic aneurysms are discovered as incidental findings on ultrasound or CT imaging
• Symptomatic aneurysms
– Mild to severe midabdominal pain due to aneurysmal expansion often radiates to lower back
– Pain may be constant or intermittent, exacerbated by even gentle pressure on aneurysm sack, and may also accompany inflammatory aneurysms
• Inflammatory aneurysms have an inflammatory peel, similar to the inflammation seen with retroperitoneal fibrosis, surrounds the aneurysm and encases adjacent retroperitoneal structures, such as the duodenum and, occasionally, the ureters
• Ruptured aneurysms
– Severe pain
– Palpable abdominal mass
– Free rupture into the peritoneal cavity is lethal
– Most aneurysms have a thick layer of thrombus lining the aneursymal sac;
– Embolization to lower extremities is rarely seen
• Even with a contained rupture, there may be little change in routine laboratory findings
• Hematocrit will be normal, since there has been no opportunity for hemodilution
• Patients with aneurysms may also have the cardiopulmonary diseases of elderly male smokers, which include
• Preoperative testing may indicate the presence of these comorbid conditions
• Abdominal ultrasonography
– Diagnostic study of choice for initial screening
– Useful in screening 65- to 74-year-old men, but not women, who have a history of smoking
– Repeated screening does not appear to be needed
• Abdominal or back radiographs: curvilinear calcifications outlining portions of aneurysm wall may be seen in approximately 75% of patients
• CT scans
• Contrast-enhanced CT scans
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