Ruptured abdominal aortic aneurysm (AAA) is a common cause of death. Abdominal aortic aneurysms tend to be asymptomatic until the time of rupture, which has a mortality rate of greater than 80%. Therefore, elective repair prior to rupture is preferred if life expectancy is reasonable and the risk of rupture outweighs the risk of repair. Mr F, a 66-year-old man with a 5.2-cm AAA, illustrates the issues surrounding monitoring and treating AAA. Risk factors for AAA include older age, male sex, smoking history, and a family history of AAA. Screening for AAA with ultrasound has been shown to prevent rupture, prevent AAA-related death, and be cost-effective. Risk factors for rupture include larger diameter, female sex, and smoking history. Endovascular repair has lower operative mortality and complications and has replaced standard open surgery in more than half of patients. However, long-term survival is similar after endovascular and open surgical repair. Those at risk of AAA who would benefit from repair should undergo screening.
A, The ultrasound shows the diameter of the infrarenal abdominal aortic aneurysm. B, Left slice shows the aneurysm and thrombus involving the infrarenal aorta. The aneurysm extends up to and possibly involves the main renal artery origins. The left slice illustrates the importance of appropriate plane when assessing diameter in the presence of angulation or tortuosity of the aorta. The horizontal line shows Mr F's aorta measurement as 5.2 cm, whereas the diagonal line shows the more accurate measurement, perpendicular to the center line of the aorta, as 4.6 cm. In both slices, a large accessory left renal artery arising from lower aorta involved in the aneurysm can be seen (yellow arrowheads). Note also the presence of 2 right renal arteries (black arrowhead). See interactive Figure of the computed tomographic angiogram here.
A, With open repair, the abdomen is opened anteriorly (as shown) or from a lateral retroperitoneal approach. The aorta is clamped, preferably below the renal arteries, and the common iliac arteries are both clamped. The aneurysm sac is opened longitudinally; backbleeding lumbar arteries and the inferior mesenteric artery are typically suture-ligated. A prosthetic graft is then sutured in place proximally and distally. A bifurcated graft (shown) is used in more than half of cases with the distal anastomoses to the common iliac or, rarely, the common femoral arteries, as opposed to a straight tube graft sewn to the aortic bifurcation. The aneurysm sac is then closed over the graft to provide separation of the graft from the intestines. B, With endovascular repair, stiff wires are introduced through the common femoral arteries over which a fabric covered stent (stent-graft) is introduced. The proximal graft is positioned just below the renal arteries. The stent-graft is initially constrained in a low-profile state until deployment. A modular device is depicted in which a separate component for the left iliac limb is inserted through and overlaps with a docking limb on the main device. Ultimately, there is a seal zone in the normal infrarenal aorta and bilateral iliac arteries, thereby excluding the abdominal aortic aneurysm. See animation of surgical procedures here.
Thank you for submitting a comment on this article. It will be reviewed by JAMA editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 17
Customize your page view by dragging & repositioning the boxes below.
Computed Tomographic Angiogram of Abdominal Aortic Aneurysm
Open and Endovascular Repair of Abdominal Aortic Aneurysm
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
Abdominal Aortic Aneurysm
The Rational Clinical Examination
Make the Diagnosis: Abdominal Aortic Aneurysm
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.