Aortic aneurysm overview: Difference between revisions

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{{SI}}
{{Aortic aneurysm}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}}
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==Overview==
==Overview==
An ''aortic aneurysm'' is a dilation of the [[aorta] representing an underlying weakness in the wall of the aorta at that location. While the stretched vessel may occasionally cause discomfort, a greater concern is the risk of ''rupture'' which causes severe pain, massive internal [[hemorrhage]] which are often fatal.
An ''aortic aneurysm'' is a dilation of the [[aorta]] representing an underlying weakness in the wall of the aorta at that location. While the stretched vessel may occasionally cause discomfort, a greater concern is the risk of ''rupture'' which causes severe pain, massive internal [[hemorrhage]] which are often fatal.


==Historical Perspective==
==Historical Perspective==
Aortic aneurysm was first discovered by Antyllus, a a Greek surgeon, in 1555.
Aortic aneurysm was first discovered by Antyllus, a a Greek surgeon, in the second century AD.


In 1817, a ligation of the abdominal aorta was used by Astley Cooper to treat a ruptured iliac aneurysm.
In 1817, a ligation of the abdominal aorta was used by Astley Cooper to treat a ruptured iliac aneurysm.
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==Differentiating aortic aneurysm from other Diseases==
==Differentiating aortic aneurysm from other Diseases==
Aortic aneurysm, when abdominal, must be differentiated from other diseases that cause either abdominal or thoracic pain, such as acute pancreatitis, ruptured viscus, and acute pericarditis.
Aortic aneurysms must be differentiated from other diseases that cause either abdominal or thoracic pain, such as acute pancreatitis, ruptured viscus, and acute pericarditis.


==Epidemiology and Demographics==
==Epidemiology and Demographics==
Line 32: Line 32:


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].


OR
Common risk factors in the development of aortic aneurysms include smoking, male gender, hypertension, race (whites) and family history.
 
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
According to the USPSTF, screening for abdominal aortic aneurysm by ultrasonography is recommended once among patients aged 65 to 75 years who have ever smoked.
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
If left untreated, 80% of patients with aortic aneurysms may progress to rupture or [[Aortic dissection|dissection]].
 
OR
 
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
The diagnosis of aortic aneurysm is based on the observed diameter of the vessel, which include diameter larger than 5 cm for the ascending aorta, 4 cm for the descending aorta, and 3cm for the abdominal aorta.
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
The majority of patients with aortic aneurysm are asymptomatic.
 
OR
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with aortic aneurysm usually appear asymptomatic. Physical examination of patients with abdominal aortic aneurysm is usually remarkable for pulsating abdominal mass. If thoracic they may present with hoarseness, dysphagia and [[aortic regurgitation]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
There are no diagnostic laboratory findings associated with aortic aneurysm.
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
There are no ECG findings associated with aortic aneurysm.
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
An x-ray may be helpful in the diagnosis of thoracic aortic aneurysm. Findings on an x-ray suggestive of thoracic aortic aneurysm include widening of the mediastinum.
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
Abdominal ultrasound may be helpful in the diagnosis of abdominal aortic aneurysm. Findings on an ultrasound diagnostic of abdominal aortic aneurysm include aorta with a diameter larger than 3 cm.
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
Thoracic or abdominal CT scan may be helpful in the diagnosis of aortic aneurysms. Findings on CT scan diagnostic of aortic aneurysms include widening of the aorta diameter.
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
Thoracic or abdominal MRI may be helpful in the diagnosis of aortic aneurysms. Findings on MRI diagnostic of aortic aneurysms include widening of the aorta diameter.
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
Angiographies may be helpful in the diagnosis of aortic aneurysms. Findings on an angiography diagnostic of aortic aneurysms include widening of the aorta diameter.
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
There are no other diagnostic studies associated with aortic aneurysm.
 
OR
 
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
Pharmacologic medical therapies for aortic aneurysms include blood pressure control and statin therapy if associated with atherosclerosis.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
The mainstay of treatment for aortic aneurysms is medical therapy. Surgery is usually reserved for patients with an abdominal aortic aneurysm larger than 5.5 cm. For thoracic aortic aneurysms, it is reserved for patients with symptoms, aneurysm that is growing more than 1 centimeter per year and/or signs of aortic dissection.
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
Effective measures for the primary prevention of aortic aneurysms include avoid smoking and controlling blood pressure.
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
Effective measures for the secondary prevention of aortic aneurysms include ultrasound screening as described above.
 
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==

Latest revision as of 15:43, 8 June 2020

Aortic aneurysm Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating aortic aneurysm from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Thoracic Aortic Aneurysm

Abdominal Aortic Aneurysm

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Treatment

Medical Therapy

Surgery

Endovascular treatment of AAA

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Aortic aneurysm overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic aneurysm overview

CDC on Aortic aneurysm overview

Aortic aneurysm overview in the news

Blogs on Aortic aneurysm overview

Directions to Hospitals Treating Aortic aneurysm overview

Risk calculators and risk factors for Aortic aneurysm overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

Overview

An aortic aneurysm is a dilation of the aorta representing an underlying weakness in the wall of the aorta at that location. While the stretched vessel may occasionally cause discomfort, a greater concern is the risk of rupture which causes severe pain, massive internal hemorrhage which are often fatal.

Historical Perspective

Aortic aneurysm was first discovered by Antyllus, a a Greek surgeon, in the second century AD.

In 1817, a ligation of the abdominal aorta was used by Astley Cooper to treat a ruptured iliac aneurysm.

Classification

Aortic aneurysm may be classified according to Crawford classification into 5 types: type 1, type 2, type 3, type 4 and type 5.

Pathophysiology

It is thought that aortic aneurysm is the result of either genetic disturbances and environmental risks such as smoking.

Causes

Aortic aneurysm may be caused by Marfan's syndrome, Loeys-Dietz syndrome, Ehler-Danlos syndrome, Turner Syndrome, Autosomal Dominant Polycystic Kidney Disease and other genetic disturbances. Its risk is greatly improved with smoking.

Differentiating aortic aneurysm from other Diseases

Aortic aneurysms must be differentiated from other diseases that cause either abdominal or thoracic pain, such as acute pancreatitis, ruptured viscus, and acute pericarditis.

Epidemiology and Demographics

The incidence of aortic aneurysm increases with age; the median age at diagnosis is 69 years.

Risk Factors

Common risk factors in the development of aortic aneurysms include smoking, male gender, hypertension, race (whites) and family history.

Screening

According to the USPSTF, screening for abdominal aortic aneurysm by ultrasonography is recommended once among patients aged 65 to 75 years who have ever smoked.

Natural History, Complications, and Prognosis

If left untreated, 80% of patients with aortic aneurysms may progress to rupture or dissection.

Diagnosis

Diagnostic Study of Choice

The diagnosis of aortic aneurysm is based on the observed diameter of the vessel, which include diameter larger than 5 cm for the ascending aorta, 4 cm for the descending aorta, and 3cm for the abdominal aorta.

History and Symptoms

The majority of patients with aortic aneurysm are asymptomatic.

Physical Examination

Patients with aortic aneurysm usually appear asymptomatic. Physical examination of patients with abdominal aortic aneurysm is usually remarkable for pulsating abdominal mass. If thoracic they may present with hoarseness, dysphagia and aortic regurgitation.

Laboratory Findings

There are no diagnostic laboratory findings associated with aortic aneurysm.

Electrocardiogram

There are no ECG findings associated with aortic aneurysm.

X-ray

An x-ray may be helpful in the diagnosis of thoracic aortic aneurysm. Findings on an x-ray suggestive of thoracic aortic aneurysm include widening of the mediastinum.

Echocardiography or Ultrasound

Abdominal ultrasound may be helpful in the diagnosis of abdominal aortic aneurysm. Findings on an ultrasound diagnostic of abdominal aortic aneurysm include aorta with a diameter larger than 3 cm.

CT scan

Thoracic or abdominal CT scan may be helpful in the diagnosis of aortic aneurysms. Findings on CT scan diagnostic of aortic aneurysms include widening of the aorta diameter.

MRI

Thoracic or abdominal MRI may be helpful in the diagnosis of aortic aneurysms. Findings on MRI diagnostic of aortic aneurysms include widening of the aorta diameter.

Other Imaging Findings

Angiographies may be helpful in the diagnosis of aortic aneurysms. Findings on an angiography diagnostic of aortic aneurysms include widening of the aorta diameter.

Other Diagnostic Studies

There are no other diagnostic studies associated with aortic aneurysm.

Treatment

Medical Therapy

Pharmacologic medical therapies for aortic aneurysms include blood pressure control and statin therapy if associated with atherosclerosis.

Surgery

The mainstay of treatment for aortic aneurysms is medical therapy. Surgery is usually reserved for patients with an abdominal aortic aneurysm larger than 5.5 cm. For thoracic aortic aneurysms, it is reserved for patients with symptoms, aneurysm that is growing more than 1 centimeter per year and/or signs of aortic dissection.

Primary Prevention

Effective measures for the primary prevention of aortic aneurysms include avoid smoking and controlling blood pressure.

Secondary Prevention

Effective measures for the secondary prevention of aortic aneurysms include ultrasound screening as described above.

References


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