Abdominal Aortic Aneurysm (AAA)


BACKGROUND

RISK FACTORS

CLINICAL FEATURES

EXAM

DIAGNOSIS

SCREENING:


ED Care & Disposition

The primary role of the emergency physician is in identifying AAA.

  1. > 5 cm in diameter = Greater risk of rupture = Vascular Surgery.
     
  2. For suspected rupturing AAA or aortoenteric fistula:
  3. Pain control should be initiated with narcotic medication as compared to NSAIDs due to medication induced platelet dysfunction. Control of pain is a compassionate intervention that may aid in control of blood pressure, but beware of hypotension.
     
  4. For chronic contained rupturing AAA:
  5. For AAA identified as an incidental finding:

 

 

Sudden onset chest/back pain
+
Pulsatile abdominal mass
STABLE UNSTABLE?
Tearing, Ripping pain

Pulsatile mass
+
Hypotension
HypOtension
Abdominal Pain
HypErtension
Chest Pain
AAA until proven otherwise
Aortic Aneurysm
Aortic Dissection
Immediate Laparotomy
Pulsatile abdominal mass
Abdominal bruit
Atherosclerosis
Intimal Tear
Inter-scapular Back Pain
Asymmetric Pulses & BP measurement
 
Abdominal Ultrasound to Dx and F/U TEE
< 5 cm 5 cm Ascending Descending
Asymptomatic Symptomatic Or Ruptured Pain in Anterior Chest Inter-scapular Back Pain

Monitor
(Ultrasound)

Surgery

Surgical Emergency

Medical Management
(Ultrasound)
AAA growing 0.5 cm in 6 months is at high risk for rupture