Basics
Description
- Focal dilation of the aortic wall with an increase in diameter by at least 50% (>3 cm)
- 95% are infrarenal.
- Gradual expansion or rupture causes symptoms.
- Rupture can occur into the intraperitoneal or retroperitoneal spaces.
- Intraperitoneal rupture is usually immediately fatal.
- Average growth rate of 0.2 to 0.5 cm per year
- 5-year risk of rupture:
- Aneurysms <4.0 cm: 2%
- Aneurysms 4.0-5.0 cm: 5%
- Aneurysms 5.0-6.0 cm: 25%
- Aneurysms 6.0-7.0 cm: 35%
- 40-50% die before they reach the hospital.
- 50% of patients who reach the hospital alive survive.
- 5-year survival after repair is 67%.
Geriatric Considerations
- Risk increases with advanced age.
- Present in 4-8% of all patients older than 65 years
- Peak incidence:
- Men: 5.9% at the age of 80 years
- Women: 4.5% at the age of 90 years
Etiology
- Risk factors:
- Male gender
- Age >65 years old
- Family history
- Cigarette smoking
- Atherosclerosis
- Hypertension
- Diabetes mellitus
- Connective tissue disorders:
- Ehlers-Danlos syndrome
- Marfan syndrome
- Uncommon causes:
- Blunt abdominal trauma
- Infections of the aorta
