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.

• Coarctation of the Aorta

  […] surgery Infectious aortitis (infections of the aorta): Due to infections such as syphilis, salmonella, or staphylococcus. [stanfordhealthcare.org]

  Marfan syndrome) and congenital abnormalities including the coarctation of the aorta (CoA). [escardio.org]

  Atherosclerosis Bicuspid aortic valve (presence of only 2 cusps, or leaflets, in the aortic valve, rather than the normal 3 cusps) Trauma Coarctation of the aorta (narrowing of the aorta) Excess fluid or volume in the circulation (hypervolemia) Polycystic [urmc.rochester.edu]

  atherosclerosis existing thoracic aneurysm bicuspid aortic valve (presence of only two cusps, or leaflets, in the aortic valve, rather than the normal three cusps) trauma coarctation of the aorta (narrowing of the aorta) hypervolemia (excess fluid or [surgery.med.miami.edu]

• Anemia

  You may need some tests before your procedure, such as: Blood tests, to check for anemia and infection An electrocardiogram, to check your heart rhythm Echocardiography, to look at the size of your aneurysm Computed tomography (CT) scan, to create detailed [saintlukeskc.org]

  These can check for anemia and infection. Electrocardiogram (ECG). This is done to check your heart rhythm. Echocardiography. This can look at the size of your aneurysm. CT scan. This creates detailed images of your aneurysm. Angiography. [hopkinsmedicine.org]

  The patient had been suffering from anemia for many years, and was taking supplements containing iron. A CT scan revealed old multifocal vascular lesions in both hemispheres of the brain. The patient was given thrombolytic treatment. [ncbi.nlm.nih.gov]

  Sickle Cell Anemia Sickle cell anemia makes red blood cells less able to carry oxygen to the body's tissues and organs, as well as stick to the walls of the blood vessels which can block arteries to the brain causing a stroke. [cirse.org]

  New-onset congestive heart failure from chronic anemia has been reported [ 40 ]. Figure 6 Upright chest film showing free air under the diaphragm. [doi.org]

• Coronary Atherosclerosis

  Circumferential stress and matrix metalloproteinase 1 in human coronary atherosclerosis. Implications for plaque rupture. Arterioscler Thromb Vasc Biol. 1996 ; 16 : 1070–1073. [doi.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]

• 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]

• Acute Abdomen

  Springer, New York; 2012. 10.1007/978-1-4419-1623-5 View Article Google Scholar Caesar R: Dangerous complaints: the acute geriatric abdomen. Emerg Med Rep 1994, 15: 191–202. [doi.org]

• 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]

• 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]

• 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]

• Abdominal Thrill

  A continuous abdominal bruit and a palpable abdominal thrill are suggestive of an aortovenous fistula. Heme-positive or grossly bloody stools can be indicative of an aortoenteric fistula. [saem.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]

• Dizziness

  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]

  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]

  Skip to content learn bedside ultrasound, one week at a time The patient is a 73 year old female with a history of remote aortic aneurysm repair who presents with complaints of dizziness, near syncope and a fall one hour PTA. [web.archive.org]

  Dizziness. Nausea and vomiting. Rapid heart rate. Shock. Your health care provider will examine your abdomen and feel the pulses in your legs. [medlineplus.gov]

• 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]

• Perseveration

  0011204 5%-29% of people have these symptoms Abnormal lower motor neuron morphology 0002366 Astrocytosis 0002446 Dysgraphia 0010526 Motor aphasia Loss of expressive speech 0002427 Mutism Inability to speak Muteness [ more ] 0002300 Parkinsonism 0001300 Perseveration [rarediseases.info.nih.gov]

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].

• Dyslipidemia

  MeSH terms Aged Aged, 80 and over Aortic Aneurysm, Abdominal/blood* Aortic Aneurysm, Abdominal/etiology Aortic Aneurysm, Abdominal/genetics* Causality Cholesterol/blood Cholesterol, HDL/blood Cholesterol, LDL/blood Dyslipidemias/blood Dyslipidemias/complications [ncbi.nlm.nih.gov]

  Gullace, G., and Ruffa, F., 1995, “Effect of Pravastatin on Abdominal Aorta and Carotid Wall Thickness in Dyslipidemia,” J. Am. Coll. Cardiol. [CrossRef], 25 (2), pp. 369A–370A. [doi.org]

  The variables recorded were: age; sex; tobacco use (smoker, >1 year ex-smoker, non-smoker); HBP (systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg or antihypertensive treatment); dyslipidemia (low density lipoprotein cholesterol ≥160mg [revespcardiol.org]

  This could be due to the advent of smokers and the rise of dyslipidemia (high blood cholesterol) and obesity. These risk factors have led to an increase in cases of atherosclerosis, which are known to increase the likelihood of an aneurysm. [news-medical.net]

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.

1. Wanhainen A. How to define an abdominal aortic aneurysm--influence on epidemiology and clinical practice. Scand J Surg 2008; 97:105.
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.