Most cases are usually asymptomatic until they expand considerably or rupture. Patients may experience pain in the abdomen, flank, back or groin. This pain is often poorly characterized and unimpressive. There could also be symptoms resulting from local compression like nausea, vomiting, early satiety, urinary frequency, thrombosis from venous obstruction and back pain from erosion into adjacent vertebrae. There could be embolic phenomena like livedoreticularis. Thrombosis will produce claudication. Patient may feel a pulsatile mass in the abdomen [5].

If the aneurysm ruptures, it presents typically with back pain. There could be transient hypotension, temporary loss of consciousness and shock. If it ruptures into the vena cava, it produces symptoms like tachycardia, leg swelling and congestive heart failure. Rupture into the fourth part of the duodenum will present as upper gastrointestinal bleeding.

• Pain

  Patients may experience pain in the abdomen, flank, back or groin. This pain is often poorly characterized and unimpressive. [symptoma.com]

  The pain in the chest or pain may be particularly severe, and may mimic a heart attack. In ruptured aneurysm or dissection, internal bleeding will occur. [emedicinehealth.com]

  The most common symptom is general belly pain or discomfort, which may come and go or be constant. Other symptoms may include: Pain in the chest, belly (abdomen), lower back, or flank (over the kidneys). [stanfordhealthcare.org]

  Chest pain or trouble breathing. Temperature of 100° or higher. Change in the temperature or color of your feet or legs. Pain in the lower back or stomach areas. [surgspecswfl.com]

  Chronic contained rupture can cause difficulties in diagnosis because there are many clinical presentations: back pain, sciatic pain, or an expansive abdominal mass. Computed tomography is the gold-standard diagnostic tool. [ncbi.nlm.nih.gov]

• Asymptomatic

  Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, but an important one is the size of the aneurysm, as risk of rupture increases with aneurysm size. [ncbi.nlm.nih.gov]

  Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, including size: risk of rupture increases with aneurysm size. [dx.doi.org]

• Inflammation

  The scans revealed chronological changes in aortic wall inflammation leading to progress and eventual rupture.This case supports a notion that aortic wall inflammation plays a role in AAA progression and rupture. [ncbi.nlm.nih.gov]

  Fever or weight loss, if the aneurysm was caused by infection or inflammation (inflammatory aortic aneurysm). The symptoms are similar to the symptoms of other problems that cause chest or belly pain. [stanfordhealthcare.org]

  Inflammation that is associated with atherosclerosis (hardening of the arteries) helps to accelerate this degenerative process even in younger people. [vascularcures.org]

• Weakness

  Abnormalities of the connective tissue in the layers of the aortic wall can contribute to weakness in sections of the aorta. [medicinenet.com]

  A bulging aorta is weak and can burst, or rupture. This causes life-threatening bleeding. If your doctor has determined that your aneurysm is small and not growing fast, it is safe to watch the aneurysm carefully and wait on surgery. [stanfordhealthcare.org]

  An Abdominal Aortic Aneurysm (AAA) is a weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. [flinterventionalspecialists.com]

  The weakness of the aorta causes bulging which results in a predisposition of rupturing or blood clotting. [verywell.com]

  A 77-year-old man with a history of acute myocardial ischemia presented with limb weakness and coldness. Contrast-enhanced computed tomography showed a 42-mm-diameter infrarenal AAA that was completely thrombosed in the distal portion. [ncbi.nlm.nih.gov]

• Collapse

  In another case with bilateral lower extremity malperfusion caused by collapse and occlusion of the endograft, extra-anatomical bypass was performed. [ncbi.nlm.nih.gov]

  Ruptured AAAs present with severe and sudden onset epigastric pain, sudden unexplained hypotension, unexplained collapse, sweating associated with a pulsatile abdominal mass. MEDICAL EMERGENCY, call for help. [geekymedics.com]

  This is called circulatory collapse, or just "shock." This is a life-threatening condition. People lose consciousness if their brain does not receive enough blood; they then may be at risk of death if the bleeding continues. [emedicinehealth.com]

  This is commonly soon followed by collapse as the internal bleeding causes a big drop in blood pressure. How is an abdominal aortic aneurysm diagnosed? Sometimes a doctor feels the bulge of an aneurysm during a routine examination of the abdomen. [patient.info]

• Cough

  When you are awake enough to breathe completely on your own and you are able to cough, the healthcare provider will remove the breathing tube. After the breathing tube is out, your nurse will help you cough and take deep breaths every 2 hours. [elcaminohospital.org]

  Symptoms of a thoracic aortic aneurysm (affecting upper part of aorta in chest): Pain in the jaw, neck, upper back or chest Coughing, hoarseness or difficulty breathing Learn more about thoracic aortic aneurysm Symptoms of an abdominal aortic aneurysm [my.clevelandclinic.org]

  Splint the incision with pillows, provide adequate pain relief prior to coughing sessions, and position the patient with the head of the bed elevated to facilitate coughing. [medical-dictionary.thefreedictionary.com]

  But as it grows, you may notice some signs, including: Chest or back pain Difficulty breathing or swallowing Shortness of breath Coughing Hoarseness Your doctor often can diagnose a thoracic aortic aneurysm with tests such as an X-ray, an echocardiogram [webmd.com]

• Dyspnea

  Contraindications to elective reconstruction MI in last 6 months, intractable angina or CHF, severe pulmonary insufficiency with dyspnea at rest, severe renal insufficiency, life expectancy of ≤ 2 years. [medical-dictionary.thefreedictionary.com]

  Doctors must pay attention for subtle signs of aortic dissection such as mild dyspnea, chest discomfort and carotid bruits, cheek peripheral pulses and blood pressure on both arms before rt-PA administration. [ncbi.nlm.nih.gov]

  Table 1 Patients’ characteristics according to absence or presence of AAA The three most frequent main symptoms leading to hospital admission were angina pectoris, dyspnea, and palpitations/syncope. [bmccardiovascdisord.biomedcentral.com]

  When thoracic aortic aneurysms are large, patients may suffer a local mass effect, such as compression of the trachea or mainstem bronchus (causing cough, dyspnea, wheezing, or recurrent pneumonitis), compression of the esophagus (causing dysphagia), [circ.ahajournals.org]

• Abdominal Pain

  Non-abdominal causes of abdominal pain Failing to consider extra-abdominal causes in the patient presenting with abdominal pain is a frequent pitfall. Several life-threatening illnesses can present with abdominal pain only. [doi.org]

  Abdominal pain is one of the most frequent reasons that elderly people visit the emergency department (ED). [ncbi.nlm.nih.gov]

• Vomiting

  A 33-year-old Chinese male suffered from Marfan syndrome combined with giant abdominal aortic aneurysm, and presented with back pain, fever, nausea, vomiting, abdominal distention, and constipation. [ncbi.nlm.nih.gov]

  You may have nausea and vomiting. You may have a rapid heart rate and clammy skin. You may pass out, and you may go into shock. A ruptured aorta is a medical emergency that is often fatal. Tratament A small aortic aneurysm may not need treatment. [capitalcardiology.com]

  The patient might feel light-headed, dizzy and nauseated or might vomit and have clammy, sweaty skin--all symptoms of the rapid fall in blood pressure. [livestrong.com]

  An AAA rupture can present with abdominal pain, back pain, syncope, or vomiting*. On examination they will typically be haemodynamically compromised, with a pulsatile abdominal mass and tenderness. [teachmesurgery.com]

• Abdominal Mass

  masses noted that imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. [emedicine.com]

  Erosion of vertebral bodies by an abdominal aortic aneurysm is extremely rare. Chronic contained rupture can cause difficulties in diagnosis because there are many clinical presentations: back pain, sciatic pain, or an expansive abdominal mass. [ncbi.nlm.nih.gov]

  An AAA rupture can present with abdominal pain, back pain, syncope, or vomiting*. On examination they will typically be haemodynamically compromised, with a pulsatile abdominal mass and tenderness. [teachmesurgery.com]

  Patients may complain of abdominal, back, or flank pain with a stable, intact AAA. However, the pain usually has a gradual onset and a dull quality. Patients may also complain of abdominal mass, fullness, or the sensation of pulsations. [saem.org]

• Nausea

  We report a case of a 56-year-old woman who presented with worsening abdominal pain located in the left upper quadrant together with abdominal distention, nausea and anorexia. [ncbi.nlm.nih.gov]

  The larger an aneurysm grows, the more likely it will burst or rupture, causing intense abdominal or back pain, dizziness, nausea or shortness of breath. [radiologyinfo.org]

  You may have nausea and vomiting. You may have a rapid heart rate and clammy skin. You may pass out, and you may go into shock. A ruptured aorta is a medical emergency that is often fatal. Tratament A small aortic aneurysm may not need treatment. [capitalcardiology.com]

• Constipation

  A 33-year-old Chinese male suffered from Marfan syndrome combined with giant abdominal aortic aneurysm, and presented with back pain, fever, nausea, vomiting, abdominal distention, and constipation. [ncbi.nlm.nih.gov]

  Though patients classically present with abdominal pain, constipation, and vomiting, nearly half do not have vomiting or constipation. Many complain of diarrhea [ 20 ]. Sigmoid and cecal volvuli also cause large bowel obstruction. [doi.org]

  Aortic Aneurysm Repair procedure: Avoid any strenuous activity for 6-8 weeks Always keep the surgical wound clean and dry Early ambulation aids in a faster recovery Use heat pad or warm compress to relieve incision pain Take stool softeners to prevent constipation [dovemed.com]

• Hypertension

  MMP-7 expression in patients with hypertension, aneurysm associated with hypertension, and healthy controls were measured by ELISA and immunohistochemical staining. [ncbi.nlm.nih.gov]

  Asymmetry of renal blood flow in patients with moderate to severe hypertension. Hypertension. 2003;41:108-13. Medline 87. Svetkey LP, Himmelstein SI, Dunnick NK. Prospective analysis of strategies for diagnosing renovascular hypertension. [revespcardiol.org]

  Other risk factors are smoking, chronic obstructive pulmonary disease, previous aneurysm repair, peripheral aneurysm, coronary artery disease and hypertension. [symptoma.com]

• Thrombosis

  Here, we report a case of an AAA complicated by inferior vena cava (IVC) thrombosis and deep venous thrombosis (DVT) due to IVC compression by aneurysm successfully treated by endovascular aneurysm repair (EVAR). [ncbi.nlm.nih.gov]

  There could also be symptoms resulting from local compression like nausea, vomiting, early satiety, urinary frequency, thrombosis from venous obstruction and back pain from erosion into adjacent vertebrae. [symptoma.com]

• Vascular Disease

  Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. 4 Gosford Vascular Services, Gosford, NSW, 2250, Australia. 5 Department of Solid Mechanics, School of Engineering Sciences, KTH Royal Institute [ncbi.nlm.nih.gov]

  Heart Insight Vascular Disease Supplement Sometimes the symptoms can be sneaky. Overcoming Aortic Aneurysm - Jason’s Story of Hope [heart.org]

  Vascular diseases change the properties of the arterial system and thus also the shape of the pressure and flow waves in the cardiovascular system. [semanticscholar.org]

• Hypotension

  A literature search using Metalib, a database search engine, provided at the Royal Free and University College of London (UCL) yielded articles using the keywords "permissive hypotension" and "hypotensive resuscitation" when linked to "abdominal aortic [ncbi.nlm.nih.gov]

  Patients in hypotensive shock with high clinical suspicion for ruptured AAA should have prompt surgical consultation before formal imaging studies. [jetem.org]

  There is no agreed upon resuscitation strategy for hypotensive patients with ruptured AAAs. Hypotensive patients may benefit from a slowing in the rate of hemorrhage and clot formation. [saem.org]

  Around 50% patients present with the ‘classic triad’ of ruptured AAA (flank or back pain, hypotension, and a pulsatile abdominal mass). *20% of AAA ruptures will rupture anteriorly into the peritoneal cavity (which are associated with a very poor prognosis [teachmesurgery.com]

• Chest Pain

  Chest pain is usually the first sign of aortic dissection. Many people describe a tearing or ripping pain in the chest when the aorta enlarges to a critical size and ruptures/dissects. [emedicinehealth.com]

  As with an AAA, symptoms may be subtle (or there may not be symptoms prior to rupture) and involve: Chest pain Back pain Shortness of breath Ruptured Aortic Aneurysm When an aortic aneurysm ruptures, symptoms can progress rapidly. [verywell.com]

  Symptoms of a thoracic aortic aneurysm (affecting upper part of aorta in chest): Pain in the jaw, neck, upper back or chest Coughing, hoarseness or difficulty breathing Learn more about thoracic aortic aneurysm Symptoms of an abdominal aortic aneurysm [my.clevelandclinic.org]

  Neither patient complained of chest pain at the moment when neurological symptoms occurred. The second patient started to complain of chest pain during rtPA infusion. The last case involved a posttraumatic thoracic aortic aneurysm. [ncbi.nlm.nih.gov]

  An abdominal aortic aneurysm that is rapidly expanding may cause abdominal, flank, or chest pain. On rare occasions, a pulsatile mass may be felt in the abdomen when there is an abdominal aortic aneurysm. [vascular.surgery.ucsf.edu]

• Ulcer

  These problems include coronary artery disease, gastroesophageal reflux disease (GERD), and peptic ulcer disease. Symptoms of a ruptured aneurysm If an aortic aneurysm bursts, or ruptures, it causes: Sudden, severe pain. [stanfordhealthcare.org]

  He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. [ncbi.nlm.nih.gov]

  […] to coronary and peripheral artery diseases, aortic diseases contribute to the wide spectrum of arterial diseases: aortic aneurysms, acute aortic syndromes (AAS) including aortic dissection (AD), intramural haematoma (IMH), penetrating atherosclerotic ulcer [escardio.org]

  Our experts can manage complex aortic disease including abdominal aortic aneurysm and all conditions associated with it, including: Aortic infection Penetrating ulcer with pseudoaneurysm (false aneurysm) Post-traumatic aneurysm Small aneurysms that thrombose [uofmhealth.org]

• Skin Ulcer

  A significant proportion of these patients develop permanent irreversible damage in the affected leg veins and their valves, resulting in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling and in extreme cases, severe skin ulcers [cirse.org]

• Back Pain

  We report the case of a 49-year-old man who suffered from back pain because of a chronic ruptured aortic aneurysm. [ncbi.nlm.nih.gov]

  This condition can cause significant abdominal pain and back pain and may lead to the artery’s leak or rupture, at which point it becomes a life-threatening emergency. [spine-health.com]

  If symptoms do occur, they are likely to be mild tummy (abdominal) or back pains. There are many causes of mild abdominal and back pain. [patient.info]

• Low Back Pain

  Chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion most commonly presents with symptoms of low back pain. [ncbi.nlm.nih.gov]

  Be sure to let your doctor know if you have felt low back pain or tenderness in your stomach area or below your ribs. Ultrasound uses sound waves to make images of your aorta and arteries on a screen. This test can measure the size of the aneurysm. [oregonsurgical.com]

  Differential Diagnosis of a Patient Referred to Physical Therapy With Low Back Pain: Abdominal Aortic Aneurysm. J Orthop Sports Phys Ther. 2008;38(9):551-557. Rodeghero J, Denninger T, Ross M. [physio-pedia.com]

  Other absolute indications for treatment are the presence of an embolic episode, disabling iliac occlusive disease, coexistence of iliac aneurysm, low back or abdominal pain attributable to the AAA and a growth rate of more than 5 mm/year. [revespcardiol.org]

• Paresthesia

  An abdominal aneurysm can impair flow to the lower extremities and cause what are known as the five Ps of ischemia: pain, pallor, pulselessness, paresthesias, and paralysis. [medical-dictionary.thefreedictionary.com]

There is no diagnostic laboratory test for abdominal aortic aneurysm. Laboratory tests are only indicated for pre-operative management like checking transfusion requirements, the possibility of an infection, renal and liver function.

Imaging techniques are used for diagnosis. Ultrasound is the standard imaging technique and has a sensitivity of 100% when performed by skilled personnel [6].

It can also show free intraperitoneal blood. Plain abdominal radiographs may show aortic wall calcification in 50% of patients. CT scan also has a 100% sensitivity and has some advantages over ultrasound. MRI, in addition to what the CT and ultrasound does offers better imaging of branch vessels. Angiography is now used less often due to advancement in CT. Echocardiography is used in known CHD patients to assess cardiac function prior to repair [7].

• Leukocytosis

  In addition, laboratory tests that yield abnormalities indicative of AC, such as leukocytosis and abnormal liver function tests, could be normal [ 49 ]. [doi.org]

  On admission blood exams showed no leukocytosis or any other inflammatory parameters. [web.archive.org]

Conservative management is reserved for patients that carry a high perioperative risk. It involves controlling the underlying risk factors like beta blockers for hypertensives and serial ultrasound measurements. Also, patients who have an aneurysm that is less than 3cm may be managed conservatively [8].

Surgery is the gold standard of abdominal wall aneurysm repair and there are two methods. The open repair in which the aorta is assessed transabdominally or via the retroperitoneal space and the aorta reconstructed from within, the aneurysm sac is closed and a graft is put into the duodenum to prevent erosion [9].

The second method is endovascular repair. This involves entering the lumen of the aorta via the femoral vessels and an endograft with a stent exoskeleton placed within the lumen of the abdominal aorta aneurysm.

Patients who suffer rupture of the aneurysm generally have a poor prognosis and less than 50% surviving the period it takes to get to the emergency room. Patient who receive timely surgical intervention before they go into severe shock have a good survival rate. For best prognosis, the condition is best identified before it ruptures as elective repair carries a lower mortality rate. Long-term prognosis is affected by other comorbidities like chronic heart failure and chronic obstructive pulmonary disease.

The cause of abdominal aortic aneurysm remains unclear although it is believed to be caused by degeneration of the aorta. Several factors have been identified as risk factors for this degeneration and subsequent aneurysm. The greatest risk factor is age greater than 65 years in men who have peripheral atherosclerotic disease. Other risk factors are smoking, chronic obstructive pulmonary disease, previous aneurysm repair, peripheral aneurysm, coronary artery disease and hypertension. Less common causes are Ehlers-Danlos syndrome, Marfan syndrome and collagen vascular disease. Gram-positive bacteria have been known to cause mycotic aneurysms. Rare causes include trauma, arteritis, cystic medial necrosis and pseudoaneurysms arising from anastomotic disruptions [2].

Ruptured abdominal aortic aneurysm is the cause of an estimated 15,000 deaths yearly in the United States which ranks it as the 13th leading cause of the death and the 10th leading cause in men aged 55 and over. The incidence of this condition varies between countries and is as high as 8.8% in Italy. In men, the incidence increases sharply from age 50 years and in women from the age of 60 years and it peaks between the ages 75-79years in both sexes. It is commoner in Caucasians than African Americans, Asians and Hispanics [3].

The main reason for this condition is failure of elastin and collagen, the structural proteins of the aorta. The loss of structural integrity and widening of the lumen begins with a degeneration of the media. There are different mechanisms responsible for development of abdominal aortic aneurysm [4].

The number of elastin layers reduces from the thoracic to the infrarenal aorta, leading to medial thinning. Also, as an individual ages, there is an increase in the concentration of proteolytic enzymes relative to the concentration of their inhibitors. This causes the media to degrade by way of increased proteolytic activity. Another mechanism is the role of metalloproteinase enzyme responsible for tissue remodeling. In aneurysm walls, there is increased activity of this enzyme. The action of immunoreactive proteins are also thought to be responsible for aneurysm formation. There is high correlation of this condition with atherosclerosis. This may be due to the atherosclerosis causing obstruction of the vasa vasorum which may lead to weakening of the aortic wall, loss of elastic recoil and degenerative ischemic changes.

This includes cessation of smoking, treatment of hypertension, healthy low-fat diet, regular exercise and screening of men aged 65 and above with ultrasound [10].

This condition is relatively common and life threatening. As the size of an aneurysm grows, the risk of rupture increases. It is usually asymptomatic, producing symptoms only when there is significant dilatation or eventual rupture [1].

Definition: This is a swelling of a part of the large artery in the abdomen. It is mostly seen in men above 65 years and is a potentially fatal condition. If it ruptures, it may kill even before the patient can access emergency care.

Cause: they include, smoking, hypertension, atherosclerosis, men over 65years, chronic obstructive lung disease, alcohol, infection and trauma.

Symptoms: they are usually not symptomatic until they rupture. When there are symptoms, it includes pain, they include pain in the abdomen, back, sides and groin. This pain is usually hard to define. There could also be a palpable mass which may be pulsating.

Diagnosis: This is done by the use of imaging techniques like ultrasound, CT scan, MRI and Angiography. They show the aneurysm and complications if they are present.

Treatment: The main treatment is surgical. It could be open when the aorta is accessed through a large abdominal or retroperitoneal incision or endograft repair which involves entering the aorta through a tiny incision in an artery.

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2. Singh K, Bønaa KH, Jacobsen BK, et al. Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study : The Tromsø Study. Am J Epidemiol 2001; 154:236.
3. Wilmink AB, Quick CR. Epidemiology and potential for prevention of abdominal aortic aneurysm. Br J Surg 1998; 85:155.
4. Wassef M, Baxter BT, Chisholm RL, Dalman RL, Fillinger MF, Heinecke J, et al. Pathogenesis of abdominal aortic aneurysms: a multidisciplinary research program supported by the National Heart, Lung, and Blood Institute. J Vasc Surg. Oct 2001;34(4):730-8.
5. Muluk SC, Gertler JP, Brewster DC, et al. Presentation and patterns of aortic aneurysms in young patients. J Vasc Surg 1994; 20:880.
6. Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160:321.
7. Daly KJ, Torella F, Ashleigh R, McCollum CN. Screening, diagnosis and advances in aortic aneurysm surgery. Gerontology. Nov-Dec 2004;50(6):349-59.
8. Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. May 2003;37(5):1106-17.
9. Stanley, J. Open surgical treatment of pararenal abdominal aortic aneurysms. In: Aortic Aneurysms, Contemporary Cardiology, Upchurch, G, Criado, E. (Eds), Humana Press, 2009. p.159
10. Wilmink TB, Quick CR, Day NE. The association between cigarette smoking and abdominal aortic aneurysms. J Vasc Surg 1999; 30:1099.