Abdominal Aortic Aneurysm
Original Editors - Justin Rosinski and Clint Morris from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Clinton Morris, Justin Rosinski, Elaine Lonnemann, Evan Thomas, Lucinda hampton, Kim Jackson, David Olukayode, Admin and WikiSysop
Definition/Description[edit | edit source]
An aneurysm is defined as an increase in the diameter of a vessel compared to normal segments by 50% or more.[1] This occurs as a result of localized weakening of the arterial wall, and must include all 3 layers (intima, media, and adventitia) of the arterial wall to be considered a true aneurysm.[1] Aneurysms are most common in the aorta, particularly the abdominal and thoracic regions, but may also affect any part of the vascular system, including lesser arteries and veins.[2]
Aneurysms are typically defined as fusiform or saccular, with fusiform aneurysm defined as a widening in the circumference of the artery in a localized area and saccular aneurysm as a localized herniation of the arterial wall.[1] A dissecting aneurysm may also develop, and is similar to a fusiform aneurysm in that it is a bilateral enlargement of arterial wall, except that there is separation of the layers of the artery.[2] A pseudoaneurysm is defined as a leaking of blood from the arterial lumen into connective tissue, contained outside of the arterial wall.[1]
Although an aneurysm may occur in any artery, they are most common in the abdominal and thoracic regions.[1] The abdominal aorta begins at the aortic hiatus in the diaphragm (approximately T12 vertebral level), and ends at approximately the L4 vertebral level, where it splits into the right and left common iliac arteries.[3] The abdominal aorta is approximately 13 cm in length.[3] In the abdominal aorta, the most common location of an AAA is just below the renal arteries.[1] The most common complications arising from an abdominal aortic aneurysm (AAA) include pain from ischemia, thromboembolism, spontaneous dissection, and rupture of the aneurysm leading to hemorrhage and possible death.[1]
Prevalence[edit | edit source]
Abdominal aortic aneurysms account for three fourths of all aortic aneurysms, and have been reported to occur four times as often as a thoracic aortic aneurysm.[1][4] Occurrence of this condition is reported as 0.5-3.2% of the general population according to the Merck Manual ranging from 1.0-14.2% in men, and 0.2-6.4% in women.[1][5] This study found geographic differences, Australia having the highest incidence, followed by America, Europe, and Asia.[5] AAA’s are much more common in men, occurring up to four to six times more often in men.[1][6] The most typical location of an AAA is below the renal arteries (80%), although they may also occur lower, involving the iliac arteries.[1][4][6] A majority of AAA’s are fusiform, though some are saccular.[1] AAA’s are reported to be the 14th leading cause of death in the United States, causing 4500 deaths directly, with an additional 1400 deaths as a result of complications during surgical repair to prevent rupture.[6] It is also reported that over 45,000 surgeries are performed each year in an effort to prevent the rupture of an AAA.[6]
Palpation Characteristics/Clinical Presentation[edit | edit source]
A large majority of abdominal aortic aneurysms are asymptomatic, and are often found incidentally as a result of other diagnostic imaging and procedures such as ultrasonography or magnetic resonance imaging.[1][6][4] Occult aneurysms may present with symptoms related to the underlying cause of the disease, such as extremity pain due to emboli, fever, malaise, etc.[1] Many AAA’s will remain asymptomatic until rupture.[6] When symptoms are produced, they typically include deep, boring pain in the abdomen, pain and tenderness to palpation, and prominent pulsating mass in the abdomen.[6][1][4] Aggarwal et al. reports that symptomatic AAA’s are also more susceptible to rupturing.[6]
A ruptured aneurysm, if it does not cause sudden death (4-5% of all sudden deaths), will present with shooting pain in the abdomen or low back, pulsatile mass in the abdomen, tachycardia and severe hypotension.[6][1] Of patients who have a ruptured AAA, half will survive to reach the hospital, and of those, only 50% will survive the surgery to repair the artery.[6]
Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
-Mechelli F, Preboski Z, Boissonnault W. 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. Abdominal Pain in Physical Therapy Practice: 3 Patient Cases. J Orthop Sports Phys Ther. 2013;43(2):44-53.
-Kim N, Kang S, Park S. Coexistence of expanding abdominal aortic aneurysm and aggravated intervertebral disc extrusion -a case report-. Korean Journal of Anesthesiology. 2013;65(4):345.
-Baskaran D, Ashraf N, Ahmad A, Menon J. Inflammatory abdominal aortic aneurysm: a persistent painful hip. Case Reports. 2013;2013(sep13 1):bcr2013009150-bcr2013009150.
-Kawatani Y, Nakamura Y, Hayashi Y, Taneichi T, Ito Y, Kurobe H et al. A Case Report on the Successful Treatment ofStreptococcus pneumoniae-Induced Infectious Abdominal Aortic Aneurysm Initially Presenting with Meningitis. Case Reports in Surgery. 2015;2015:1-6.
Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Porter RS, Kaplan JL. The Merck manual of diagnosis and therapy. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2011.
- ↑ 2.0 2.1 Goodman CC, Fuller KS. Pathology: implications for the physical therapist. St. Louis, MO: Saunders/Elsevier; 2009.
- ↑ 3.0 3.1 Moore KL, Agur AMR, Dalley AF, Moore KL. Essential clinical anatomy. Baltimore, MD: Lippincott Williams & Wilkins; 2015.
- ↑ 4.0 4.1 4.2 4.3 Goodman CC, Snyder TEK. Differential diagnosis for physical therapists: screening for referral. St. Louis, MO: Saunders/Elsevier; 2013.
- ↑ 5.0 5.1 Li X, Zhao G, Zhang J, Duan Z, Xin S. Prevalence and Trends of the Abdominal Aortic Aneurysms Epidemic in General Population - A Meta-Analysis. Plos ONE [serial on the Internet]. (2013, Dec), [cited March 24, 2016]; 8(12): 1-11. Available from: Academic Search Complete.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: A comprehensive review. Experimental And Clinical Cardiology [serial on the Internet]. (2011, 2011 Spring), [cited March 24, 2016]; 16(1): 11-15. Available from: MEDLINE.
