Abdominal aortic aneurysm

An abdominal aortic aneurysm (AAA) is a lethal disease. Abdominal ultrasound (US) is used to screen patients for an AAA. Several screening guidelines have recently been released with variable recommendations about whom to screen. It is reasonable to screen patients aged 60 and older, particularly males, women with cardiovascular risk factors, smokers, and patients with a family history of AAA, as these appear to be the major risk factors. Patients with small (<5.5 cm) AAAs should be followed with serial US. Medical management should focus on managing comorbidities, especially those that place patients at risk for other cardiovascular disease, such as smoking and hypertension. Patients with large or symptomatic AAAs should be prepared for surgery, including careful imaging of the abdomen, and placed on a perioperative beta-blocker and a statin to lower LDL cholesterol to less than 70 ng/dL. Endovascular repair has lower short-term mortality and morbidity versus conventional open repair, and trials assessing long-term results are in progress. Basic science and translational research focusing on the underlying pathogenesis of AAAs will likely pave the way for future medical therapies.