Abstract
Introduction: Abdominal aortic aneurysm (AAA) is defined as an abdominal aortic dilation of three cm or more. It is well established that the prevalence of AAA increases with age. It is rare in persons younger than fifty years old; but it is estimated that twelve percent of males and five percent females 74 to 84 years of age have AAA. It is responsible for about 11,000 mortality in the US annually. The mortality rates from ruptured AAAs can be more than ninety percent.
Aneurysms develop due to degeneration process of the arterial media and elastic tissues. Risk factors for AAA are the same as those of other cardiovascular problems. The main risk factors are male, smoker, older than 65 years, coronary artery disease, hypertension, previous myocardial infarction, peripheral arterial disease, and a family history of AAA. Blacks are at lower risk than other ethnicities.
Afar from the inherent risk of rupture, patients with AAA are also at an increased risk of cardiovascular disease and death independent of other factors. The degree to which risk factors affect AAA vs. atherosclerosis varies. dyslipidemia is a crucial coronary artery disease risk factor, though its role in AAA continues to be indeterminant, and diabetes mellitus could have a negative association with AAA.
Aim of work: In this review, we will discuss the most recent evidence regarding surgical management of abdominal aortic aneurysm.
Methodology: We did a systematic search for surgical management of abdominal aortic aneurysm using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.
Conclusions: Abdominal aortic aneurysm denotes to abdominal aortic dilation of three cm or more. The most important risk factors are age older than 65 years, male sex, and smoking history. Other risk factors consist of family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis can be made by physical examination, an incidental finding on imaging, or ultrasonography. Men 65 to 75 years of age with a history of smoking must have at least one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Males in this age group without a hi7story of smoking could potentially benefit if they have other risk factors such as family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease. There is inconsistent evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Females without a smoking history should not undergo screening as the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should have regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is classically recommended for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is considered a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It has high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate.