Aortic aneurysm

Aortic aneurysm
Aortic aneurysm
	Figure A shows a normal aorta. Figure B shows a thoracic aortic aneurysm (which is located behind the heart). Figure C shows an abdominal aortic aneurysm located below the arteries that supply blood to the kidneys.
Specialty	Cardiology, Vascular surgery
Symptoms	abdominal pain and back pain
Complications	Hemorrhaging
Diagnostic method	ultrasound

An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size.^[1] Typically, there are no symptoms except when the aneurysm dissects or ruptures, which causes sudden, severe pain in the abdomen and lower back.^[2]^[3]

The etiology remains an area of active research. Known causes include trauma, infection, and inflammatory disorders. Risk factors include cigarette smoking, extreme alcoholism, advanced age, dyslipidemia, hypertension, and coronary artery disease.^[4] The pathophysiology of the disease is related to an initial arterial insult causing a cascade of inflammation and extracellular matrix protein breakdown by proteinases leading to arterial wall weakening.^[5] They are most commonly located in the abdominal aorta, but can also be located in the thoracic aorta.

Aortic aneurysms result from a weakness in the wall of the aorta and increase the risk of aortic rupture. When rupture occurs, massive internal bleeding results and, unless treated immediately, shock and death can occur. One review stated that up to 81% of people having abdominal aortic aneurysm rupture will die, with 32% dying before reaching a hospital.^[6]

According to a review of global data through 2019, the prevalence of abdominal aortic aneurysm worldwide was about 0.9% in people under age 79 years, and is about four times higher in men than in women at any age.^[4] Death occurs in about 55-64% of people having rupture of the AAA.^[4]

Screening with ultrasound is indicated in those at high risk. Prevention is by decreasing risk factors, such as smoking, and treatment is either by open or endovascular surgery. Aortic aneurysms resulted in about 152,000 deaths worldwide in 2013, up from 100,000 in 1990.^[7]

^ Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC (March 1991). "Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery". Journal of Vascular Surgery. 13 (3): 452–458. doi:10.1067/mva.1991.26737. PMID 1999868.
^ Cite error: The named reference Kent2014 was invoked but never defined (see the help page).
^ Upchurch GR, Schaub TA (April 2006). "Abdominal aortic aneurysm". American Family Physician. 73 (7): 1198–1204. PMID 16623206.
^ ^a ^b ^c Song P, He Y, Adeloye D, et al. (June 2023). "The Global and Regional Prevalence of Abdominal Aortic Aneurysms: A Systematic Review and Modeling Analysis". Annals of Surgery. 277 (6): 912–919. doi:10.1097/SLA.0000000000005716. PMC 10174099. PMID 36177847.
^ Anagnostakos J, Lal BK (March 2021). "Abdominal aortic aneurysms". Progress in Cardiovascular Diseases. 65: 34–43. doi:10.1016/j.pcad.2021.03.009. PMID 33831398. S2CID 233192017.
^ Reimerink JJ, van der Laan MJ, Koelemay MJ, Balm R, Legemate DA (October 2013). "Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm". The British Journal of Surgery. 100 (11): 1405–13. doi:10.1002/bjs.9235. PMID 24037558.
^ GBD 2013 Mortality Causes of Death Collaborators (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.

[pmid1999868-1] Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC (March 1991). "Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery". Journal of Vascular Surgery. 13 (3): 452–458. doi:10.1067/mva.1991.26737. PMID 1999868.

[Kent2014-2] Cite error: The named reference Kent2014 was invoked but never defined (see the help page).

[AFP2006-3] Upchurch GR, Schaub TA (April 2006). "Abdominal aortic aneurysm". American Family Physician. 73 (7): 1198–1204. PMID 16623206.

[song-4] Song P, He Y, Adeloye D, et al. (June 2023). "The Global and Regional Prevalence of Abdominal Aortic Aneurysms: A Systematic Review and Modeling Analysis". Annals of Surgery. 277 (6): 912–919. doi:10.1097/SLA.0000000000005716. PMC 10174099. PMID 36177847.

[5] Anagnostakos J, Lal BK (March 2021). "Abdominal aortic aneurysms". Progress in Cardiovascular Diseases. 65: 34–43. doi:10.1016/j.pcad.2021.03.009. PMID 33831398. S2CID 233192017.

[reim-6] Reimerink JJ, van der Laan MJ, Koelemay MJ, Balm R, Legemate DA (October 2013). "Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm". The British Journal of Surgery. 100 (11): 1405–13. doi:10.1002/bjs.9235. PMID 24037558.

[GDB2013-7] GBD 2013 Mortality Causes of Death Collaborators (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.

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