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==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Abdominal aortic aneurysm is a life-threatening condition and must be treated as such irrespective of the underlying cause.  
Abdominal aortic aneurysm is a life-threatening condition and must be treated as such irrespective of the underlying cause.


*[[Abdominal trauma]]
*[[Abdominal trauma]]
Line 32: Line 32:
:❑ Majority of the patients are asymptomatic (Detected incidentally)<br>
:❑ Majority of the patients are asymptomatic (Detected incidentally)<br>
❑ Symptomatic but not ruptured
❑ Symptomatic but not ruptured
:❑ Pain described as severe, sudden, persistent, or constant<br>
:❑ Pain with an indolent onset <br>
::❑ Abdominal pain
::❑ Abdominal pain
::❑ Back pain
::❑ Back pain  
::❑ Groin pain (scrotum)
::❑ Groin pain (scrotum)
:❑ Pulsating sensations in the abdomen
:❑ Pulsating sensations in the abdomen
:❑ Limb ischemia  
:❑ Limb ischemia (suggestive of embolism of thrombus or atherosclerotic debris)
:❑ Systemic manifestations
:❑ Systemic manifestations(suggestive of primary aortic infection with aneurysm formation or secondary infection of an established AAA)
::❑ Fever <br>
::❑ Fever <br>
::❑  Malaise
::❑  Malaise
❑ Symptomatic and ruptured
❑ Symptomatic and ruptured
:❑ Severe pain
:❑ Severe pain described as  severe, sudden, persistent, or constant
::❑ Back/flank pain (suggestive of proximal aortic rupture near the renal arteries)
::❑ Abdominal/pelvic pain (distal rupture near the iliac bifurcation)
::❑ Pain that radiates to the groin or thigh (suggestive of lumbar nerve irritation)
:❑ Hypotension
:❑ Hypotension
:❑ [[Syncope]], [[loss of consciousness|fainting]] (suggestive of [[hemorrhage]])<br>
:❑ [[Syncope]], [[loss of consciousness|fainting]] (suggestive of [[hemorrhage]])
:❑ [[Anxiety]]<br>
:❑ Symptoms of myocardial infarction (due to acute blood loss)
:❑ [[Palpitation]]<br>
::❑ Chest pain radiating to the lower jaw, neck, right arm, back, and upper abdomen
:❑ [[Sweating]]<br>
::❑ [[Anxiety]]<br>
:❑ [[pulse|Rapid, weak pulse]]<br>
::❑ [[Palpitation]]<br>
:❑ [[Dyspnea|Shortness of breath]]<br>
::❑ [[Sweating]]<br>
:❑ [[Tachypnea|Rapid breathing]]
::❑ [[pulse|Rapid, weak pulse]]<br>
:❑ [[Clammy skin]]<br></div>}}
::❑ [[Dyspnea|Shortness of breath]]<br>
::❑ [[Tachypnea|Rapid breathing]]
::❑ [[Clammy skin]]<br>
:❑ Symptoms of heart failure (suggestive of arteriovenous fistula as a result of rupture of the aorta into a surrounding venous structure )
:❑ Hematuria (suggestive of aortocaval fistula)
:❑ Massive leg swelling and lower extremity cyanosis (suggestive of aortocaval fistula)
:❑ Groin pain and hernia (suggestive of aortocaval fistula)
:❑ Upper gastrointestinal bleeding (suggestive of aortoduodenal fistula) </div>}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | B01 | | | | | | | | | | | | |B01=<div style="float: left; text-align: left;  padding:1em;"> Obtain a detailed history:
{{familytree | | | | | | | | | B01 | | | | | | | | | | | | |B01=<div style="float: left; text-align: left;  padding:1em;"> Obtain a detailed history:
❑ Smoking History (Strongest risk factor) (smoked at some point in their life)<ref name="Greenhalgh RM, Powell JT 2008 494–501">{{cite journal |author=Greenhalgh RM, Powell JT |title=Endovascular repair of abdominal aortic aneurysm |journal=N. Engl. J. Med. |volume=358 |issue=5 |pages=494–501 |date= |pmid=18234753 |doi=10.1056/NEJMct0707524 }}</ref> <br>
❑ History to find out the risk factors for development of aneurysm
❑ History to find out the risk factors for development of aneurysm
:❑ Hyperlipidemia
:❑ Hyperlipidemia
Line 62: Line 71:
::❑ Relapsing polychondritis
::❑ Relapsing polychondritis
::❑ Pseudoxanthoma elasticum
::❑ Pseudoxanthoma elasticum
::❑ Polycystic kidney disease
::❑ Loeys-Dietz syndrome
::❑ Turner's syndrome
:❑ COPD (Emphysema)
:❑ COPD (Emphysema)
:❑ Hypertension
:❑ Hypertension
Line 72: Line 84:
:❑ Cardiac or renal transplant
:❑ Cardiac or renal transplant
:❑  Hypertension
:❑  Hypertension
❑ Family history<ref>{{cite journal |author=Clifton MA |title=Familial abdominal aortic aneurysms |journal=Br J Surg. |volume=64 |issue=11 |pages=765–6 |date=Nov 1977 |pmid=588966|doi=10.1002/bjs.1800641102 }}</ref>  
❑ Family history<ref>{{cite journal |author=Clifton MA |title=Familial abdominal aortic aneurysms |journal=Br J Surg. |volume=64 |issue=11 |pages=765–6 |date=Nov 1977 |pmid=588966|doi=10.1002/bjs.1800641102 }}</ref>
:❑ Abdominal aortic aneurysm
:❑ Alpha 1-antitrypsin deficiency
:❑ Alpha 1-antitrypsin deficiency
❑ Diabetes mellitus (Negatively associated with AAA)<br>
❑ Past Medical History
❑ Atherosclerosis<br>
:❑ Diabetes mellitus (Negatively associated with AAA)<br>
❑ Peripheral artery disease<br>
:❑ Atherosclerosis<br>
Alcohol History<br>
:❑ Peripheral artery disease<br>
❑ Hemorrhoids<br>
:Giant cell arteritis<ref name="Josselin-Mahr-2013">{{Cite journal  | last1 = Josselin-Mahr | first1 = L. | last2 = El Hessen | first2 = TA. | last3 = Toledano | first3 = C. | last4 = Fardet | first4 = L. | last5 = Kettaneh | first5 = A. | last6 = Tiev | first6 = K. | last7 = Cabane | first7 = J. | title = [Inflammatory aortitis in giant cell arteritis]. | journal = Presse Med | volume = 42 | issue = 2 | pages = 151-9 | month = Feb | year = 2013 | doi = 10.1016/j.lpm.2012.03.003 | PMID = 22552044 }}</ref> <br>
❑ Esophageal varices<br>
:❑ Hemorrhoids<br>
Infection<br>
:❑ Esophageal varices<br>
Social History
:❑ Smoking History (Strongest risk factor) (smoked at some point in their life)<ref name="Greenhalgh RM, Powell JT 2008 494–501">{{cite journal |author=Greenhalgh RM, Powell JT |title=Endovascular repair of abdominal aortic aneurysm |journal=N. Engl. J. Med. |volume=358 |issue=5 |pages=494–501 |date= |pmid=18234753 |doi=10.1056/NEJMct0707524 }}</ref> <br>
:❑ Alcohol History<br>
❑ Anatomic deformities
:❑ Bicuspid aortic valve
:❑ Coarctation of the aorta
❑ Infections of the aorta (aortitis)(very rare)<br>
:❑ Syphilis
:❑ Salmonella
:❑ Staphylococcus
❑ Trauma <br>
❑ Trauma <br>
❑ Arteritis <br>
❑ Arteritis <br>
❑ Cystic medial necrosis </div>}}
❑ Cystic medial necrosis </div>}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | C01 | | | | | | | | | | | |C01= <div style="float: left; text-align: left;  padding:1em;">  Examine the patient: <br>
'''Vitals'''<br>
❑ [[Temperature]]
:❑ [[Fever]] ( suggestive of infected aneurysm)
❑ [[Pulse]]  <br>
:❑ Rate  <br>
::❑ [[Tachycardia]] (due to increased blood loss)  <br>
::❑ [[Bradycardia]] (suggestive of shock)  <br>
:❑ Symmetry  <br>
::❑ Asymmetric pulses (suggestive of aortic pathology in the chest)  <br>
❑ [[Blood pressure]]  <br>
:❑ [[Hypotension]] (suggestive of rupture of the aneurysm)  <br>
:❑ [[Hypertension]] (suggestive of expansile aneurysm)  <br>
❑ [[Respiratory rate]]  <br>
:❑ [[Tachypnea]] (suggestive of shock)  <br>
'''Skin'''  <br>
❑ [[Cyanosis]] (suggestive of frank shock or rupture of the aneurysm)  <br>
'''Neck'''  <br>
❑ [[Carotid bruits]] (suggestive of atherosclerosis)  <br>
❑ Elevated [[jugular venous pressure]] (suggestive of heart failure due to arteriovenous fistula)
'''Abdomen''' <br>
❑ [[Abdominal distention]] (suggestive of hernia due to increased intrabdominal pressure) <br>
❑ [[Abdominal tenderness]]  <br>
❑ [[Rebound tenderness]]  <br>
❑ Pulsatile [[Abdominal mass]] <ref name="Fink-2000">{{Cite journal  | last1 = Fink | first1 = HA. | last2 = Lederle | first2 = FA. | last3 = Roth | first3 = CS. | last4 = Bowles | first4 = CA. | last5 = Nelson | first5 = DB. | last6 = Haas | first6 = MA. | title = The accuracy of physical examination to detect abdominal aortic aneurysm. | journal = Arch Intern Med | volume = 160 | issue = 6 | pages = 833-6 | month = Mar | year = 2000 | doi =  | PMID = 10737283 }}</ref>
❑ Signs of retroperitoneal hematoma
:❑ Ecchymosis in the flank (Grey-Turner's sign)
:❑ Ecchymosis around the umbilicus (Cullen’s sign)
:❑ Discoloration of the scrotum (Bryant’s sign)(suggestive of retroperitoneal hematoma)
:❑  Ecchymosis of the proximal thigh (Fox’s sign)
'''Extremities''' <br>
❑ Peripheral artery aneurysm (eg, femoral, popliteal)
❑  Signs of limb[[ischemia]] (suggestive of embolism of thrombus or atherosclerotic debris from the aneurysm)<ref name="Baxter-1990">{{Cite journal  | last1 = Baxter | first1 = BT. | last2 = McGee | first2 = GS. | last3 = Flinn | first3 = WR. | last4 = McCarthy | first4 = WJ. | last5 = Pearce | first5 = WH. | last6 = Yao | first6 = JS. | title = Distal embolization as a presenting symptom of aortic aneurysms. | journal = Am J Surg | volume = 160 | issue = 2 | pages = 197-201 | month = Aug | year = 1990 | doi =  | PMID = 2200293 }}</ref><ref name="Nigro-2011">{{Cite journal  | last1 = Nigro | first1 = G. | last2 = Giovannacci | first2 = L. | last3 = Engelberger | first3 = S. | last4 = Van den Berg | first4 = JC. | last5 = Rosso | first5 = R. | title = The challenge of posttraumatic thrombus embolization from abdominal aortic aneurysm causing acute limb ischemia. | journal = J Vasc Surg | volume = 54 | issue = 3 | pages = 840-3 | month = Sep | year = 2011 | doi = 10.1016/j.jvs.2011.01.051 | PMID = 21477964 }}</ref>
:❑ Painful
:❑ Pulseless
:❑ Pale in color
:❑ Perishing cold- Freezing cold feeling, a painful cold temperature.
:❑ Paraesthetic feeling such as burning or tingling
:❑ Paralysed  <br>
❑ Claudication (suggestive of peripheral artery disease) </div>}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | D01 |-|-|-|-| D02 | | | | | | |D01= <div style="float: left; text-align: left;  padding:1em;"> Consider alternate diagnosis:
:❑ [[Acute cholecystitis]]
:❑ [[Gastritis]] and [[peptic ulcer disease]]
:❑ [[Gastrointestinal bleeding]]
:❑ [[Ischemic bowel]]
:❑ [[Diverticulitis]]
:❑ [[Nephrolithiasis]]
:❑ [[Pyelonephritis]]
:❑ [[Appendicitis]]
:❑ [[Cholelithiasis]]
:❑ [[Large bowel obstruction]]
:❑ [[Small bowel obstruction]]
:❑ [[Pancreatitis]]
:❑ [[Musculoskeletal pain]]
:❑ [[Myocardial infarction]]
:❑ [[Urinary tract infection]] in women</div>|D02=<div style="float: left; text-align: left;  padding:1em;">
❑'''Symptomatic and unstable'''
:❑ For unstable patient with a known AAA
:::::::    OR
:❑ Patients presenting with classic symptoms and signs of rupture
::❑ Abdominal/back/flank pain,
::❑ Hypotension
::❑ Pulsatile mass
</div>}}
{{familytree | | | | | | | | | |!| | | | | | |!| | | | | |}}
{{familytree | | | | | | | | | E01 | | | | | E02 | | | | | |E01=<div style="float: left; text-align: left;  padding:1em;"> '''Order lab tests:'''
❑ For patients with acute abdominal complaints
:❑ Complete blood count
:❑ Electrolytes
:❑ Blood urea nitrogen
:❑ Creatinine
❑ Additional tests for patients presenting with shock
:❑ Liver function tests
:❑ Coagulation parameters
:❑ Fibrinogen
:❑ Fibrin split products
:❑ Arterial blood gases
:❑ Lactate level
:❑ Cardiac enzymes
:❑ Toxicology studies
❑ Order Imaging study
:❑ Abdominal ultrasound (preferred in asymptomatic patients)
::❑ Measure the anteroposterior (AP), longitudinal and transverse dimensions of the aorta
::❑  Do a Focused Assessment with Sonography in Trauma (FAST) exam to rule out retroperitoneal hematoma (in hemodynamically unstable patients)
:❑ Computed tomography (CT)(used in symptomatic but stable patients)
::❑ Differentiates ruptured from nonruptured aneurysm
::❑ Can evaluate suprarenal aneurysms
::❑ Helps defining the extent of the aneurysm to plan for surgery
:❑ Magnetic resonance imaging (MRI) (used in known AAA (unrepaired or post-repair) with contraindications to contrast)</div>|E02=<div style="float: left; text-align: left;  padding:1em;">  ❑ Take this patients to the operating room for immediate management and<br>
diagnose intraoperatively
❑'''Imaging is highly desirable, but is not absolutely required prior to intervention'''</div> }}
{{familytree | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | B01 | | | | B02 | | | | | | | | | | |}}
{{familytree | | | | | | B01 | | | | B02 | | | | | | | | | | |B02=}}
{{familytree | | | | | | |!| | | | | |!| | | | | | | | | |}}
{{familytree | | | | | | |!| | | | | |!| | | | | | | | | |}}
{{familytree | | | | | | C01 | | | | C02 | | | | | | | | | | |}}
{{familytree | | | | | | C01 | | | | C02 | | | | | | | | | | |}}

Latest revision as of 14:28, 15 May 2014

Overview

An abdominal aortic aneurysm is a localized dilatation of the abdominal aorta, that exceeds the normal diameter of the abdominal aorta by more than 50%. The normal diameter of an aorta depends on the patient's age, sex, height, weight, race, body surface area, and baseline blood pressure. On average, the normal diameter of the infrarenal aorta is 2 cm, and therefore a true AAA measures 3.0 cm or more. Aortic ectasia is a mild generalized dilatation (<50% of the normal diameter of ≤ 2.9 cm) that is due to age-related degenerative changes in the vessel walls.

Causes

Life Threatening Causes

Abdominal aortic aneurysm is a life-threatening condition and must be treated as such irrespective of the underlying cause.

Common Causes


FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

Abbreviations:


Complete Diagnostic Approach

A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.

 
 
 
 
 
 
 
 
Characterize the symptoms:

❑ Asymptomatic

❑ Majority of the patients are asymptomatic (Detected incidentally)

❑ Symptomatic but not ruptured

❑ Pain with an indolent onset
❑ Abdominal pain
❑ Back pain
❑ Groin pain (scrotum)
❑ Pulsating sensations in the abdomen
❑ Limb ischemia (suggestive of embolism of thrombus or atherosclerotic debris)
❑ Systemic manifestations(suggestive of primary aortic infection with aneurysm formation or secondary infection of an established AAA)
❑ Fever
❑ Malaise

❑ Symptomatic and ruptured

❑ Severe pain described as severe, sudden, persistent, or constant
❑ Back/flank pain (suggestive of proximal aortic rupture near the renal arteries)
❑ Abdominal/pelvic pain (distal rupture near the iliac bifurcation)
❑ Pain that radiates to the groin or thigh (suggestive of lumbar nerve irritation)
❑ Hypotension
Syncope, fainting (suggestive of hemorrhage)
❑ Symptoms of myocardial infarction (due to acute blood loss)
❑ Chest pain radiating to the lower jaw, neck, right arm, back, and upper abdomen
Anxiety
Palpitation
Sweating
Rapid, weak pulse
Shortness of breath
Rapid breathing
Clammy skin
❑ Symptoms of heart failure (suggestive of arteriovenous fistula as a result of rupture of the aorta into a surrounding venous structure )
❑ Hematuria (suggestive of aortocaval fistula)
❑ Massive leg swelling and lower extremity cyanosis (suggestive of aortocaval fistula)
❑ Groin pain and hernia (suggestive of aortocaval fistula)
❑ Upper gastrointestinal bleeding (suggestive of aortoduodenal fistula)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain a detailed history:

❑ History to find out the risk factors for development of aneurysm

❑ Hyperlipidemia
❑ Connective tissue disorder[3]
❑ Marfan syndrome
❑ Ehlers-Danlos syndrome
❑ Relapsing polychondritis
❑ Pseudoxanthoma elasticum
❑ Polycystic kidney disease
❑ Loeys-Dietz syndrome
❑ Turner's syndrome
❑ COPD (Emphysema)
❑ Hypertension

❑ History to find out the risk factors for expansion of aneurysm

❑ Cardiac or renal transplant
❑ Stroke
❑ Cardiac disease

❑ History to find out the risk factors for rupture of aneurysm

❑ Female gender
❑ Cardiac or renal transplant
❑ Hypertension

❑ Family history[4]

❑ Abdominal aortic aneurysm
❑ Alpha 1-antitrypsin deficiency

❑ Past Medical History

❑ Diabetes mellitus (Negatively associated with AAA)
❑ Atherosclerosis
❑ Peripheral artery disease
❑ Giant cell arteritis[5]
❑ Hemorrhoids
❑ Esophageal varices

❑ Social History

❑ Smoking History (Strongest risk factor) (smoked at some point in their life)[6]
❑ Alcohol History

❑ Anatomic deformities

❑ Bicuspid aortic valve
❑ Coarctation of the aorta

❑ Infections of the aorta (aortitis)(very rare)

❑ Syphilis
❑ Salmonella
❑ Staphylococcus

❑ Trauma
❑ Arteritis

❑ Cystic medial necrosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:

Vitals
Temperature

Fever ( suggestive of infected aneurysm)

Pulse

❑ Rate
Tachycardia (due to increased blood loss)
Bradycardia (suggestive of shock)
❑ Symmetry
❑ Asymmetric pulses (suggestive of aortic pathology in the chest)

Blood pressure

Hypotension (suggestive of rupture of the aneurysm)
Hypertension (suggestive of expansile aneurysm)

Respiratory rate

Tachypnea (suggestive of shock)

Skin
Cyanosis (suggestive of frank shock or rupture of the aneurysm)
Neck
Carotid bruits (suggestive of atherosclerosis)
❑ Elevated jugular venous pressure (suggestive of heart failure due to arteriovenous fistula) Abdomen
Abdominal distention (suggestive of hernia due to increased intrabdominal pressure)
Abdominal tenderness
Rebound tenderness
❑ Pulsatile Abdominal mass [7] ❑ Signs of retroperitoneal hematoma

❑ Ecchymosis in the flank (Grey-Turner's sign)
❑ Ecchymosis around the umbilicus (Cullen’s sign)
❑ Discoloration of the scrotum (Bryant’s sign)(suggestive of retroperitoneal hematoma)
❑ Ecchymosis of the proximal thigh (Fox’s sign)

Extremities
❑ Peripheral artery aneurysm (eg, femoral, popliteal) ❑ Signs of limbischemia (suggestive of embolism of thrombus or atherosclerotic debris from the aneurysm)[8][9]

❑ Painful
❑ Pulseless
❑ Pale in color
❑ Perishing cold- Freezing cold feeling, a painful cold temperature.
❑ Paraesthetic feeling such as burning or tingling
❑ Paralysed
❑ Claudication (suggestive of peripheral artery disease)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Symptomatic and unstable

❑ For unstable patient with a known AAA
OR
❑ Patients presenting with classic symptoms and signs of rupture
❑ Abdominal/back/flank pain,
❑ Hypotension
❑ Pulsatile mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order lab tests:

❑ For patients with acute abdominal complaints

❑ Complete blood count
❑ Electrolytes
❑ Blood urea nitrogen
❑ Creatinine

❑ Additional tests for patients presenting with shock

❑ Liver function tests
❑ Coagulation parameters
❑ Fibrinogen
❑ Fibrin split products
❑ Arterial blood gases
❑ Lactate level
❑ Cardiac enzymes
❑ Toxicology studies

❑ Order Imaging study

❑ Abdominal ultrasound (preferred in asymptomatic patients)
❑ Measure the anteroposterior (AP), longitudinal and transverse dimensions of the aorta
❑ Do a Focused Assessment with Sonography in Trauma (FAST) exam to rule out retroperitoneal hematoma (in hemodynamically unstable patients)
❑ Computed tomography (CT)(used in symptomatic but stable patients)
❑ Differentiates ruptured from nonruptured aneurysm
❑ Can evaluate suprarenal aneurysms
❑ Helps defining the extent of the aneurysm to plan for surgery
❑ Magnetic resonance imaging (MRI) (used in known AAA (unrepaired or post-repair) with contraindications to contrast)
 
 
 
 
❑ Take this patients to the operating room for immediate management and
diagnose intraoperatively
Imaging is highly desirable, but is not absolutely required prior to intervention
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ B01 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ C01 }}}
 
 
 
{{{ C02 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ D01 }}}
 
 
 
{{{ D02 }}}
 
 
{{{ D03 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ F01 }}}
 
 
 
{{{ F02 }}}
 
 
{{{ F03}}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ G01 }}}
 
{{{ G02 }}}
 
 
 
{{{ G03 }}}
 
 
 
{{{ G04 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of Abdominal aortic aneurysm according the the [...] guidelines.


Do's

Don'ts

  1. Singh, K.; Bønaa, KH.; Jacobsen, BK.; Bjørk, L.; Solberg, S. (2001). "Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study : The Tromsø Study". Am J Epidemiol. 154 (3): 236–44. PMID 11479188. Unknown parameter |month= ignored (help)
  2. Santosa, F.; Schrader, S.; Nowak, T.; Luther, B.; Kröger, K.; Bufe, A. (2013). "Thoracal, abdominal and thoracoabdominal aortic aneurysm". Int Angiol. 32 (5): 501–5. PMID 23903309. Unknown parameter |month= ignored (help)
  3. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
  4. Clifton MA (Nov 1977). "Familial abdominal aortic aneurysms". Br J Surg. 64 (11): 765–6. doi:10.1002/bjs.1800641102. PMID 588966.
  5. Josselin-Mahr, L.; El Hessen, TA.; Toledano, C.; Fardet, L.; Kettaneh, A.; Tiev, K.; Cabane, J. (2013). "[Inflammatory aortitis in giant cell arteritis]". Presse Med. 42 (2): 151–9. doi:10.1016/j.lpm.2012.03.003. PMID 22552044. Unknown parameter |month= ignored (help)
  6. Greenhalgh RM, Powell JT. "Endovascular repair of abdominal aortic aneurysm". N. Engl. J. Med. 358 (5): 494–501. doi:10.1056/NEJMct0707524. PMID 18234753.
  7. Fink, HA.; Lederle, FA.; Roth, CS.; Bowles, CA.; Nelson, DB.; Haas, MA. (2000). "The accuracy of physical examination to detect abdominal aortic aneurysm". Arch Intern Med. 160 (6): 833–6. PMID 10737283. Unknown parameter |month= ignored (help)
  8. Baxter, BT.; McGee, GS.; Flinn, WR.; McCarthy, WJ.; Pearce, WH.; Yao, JS. (1990). "Distal embolization as a presenting symptom of aortic aneurysms". Am J Surg. 160 (2): 197–201. PMID 2200293. Unknown parameter |month= ignored (help)
  9. Nigro, G.; Giovannacci, L.; Engelberger, S.; Van den Berg, JC.; Rosso, R. (2011). "The challenge of posttraumatic thrombus embolization from abdominal aortic aneurysm causing acute limb ischemia". J Vasc Surg. 54 (3): 840–3. doi:10.1016/j.jvs.2011.01.051. PMID 21477964. Unknown parameter |month= ignored (help)