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INTRODUCTION — Approximately 15,000 deaths annually in the United States are attributed to
abdominal aortic aneurysms (AAA) [1]. The established therapeutic approach to this problem has
been surgical replacement of the aneurysm with a prosthetic graft. The morbidity and mortality rates
have fallen to acceptable levels for elective cases (mortality less than 5 percent). By contrast,
mortality rates are still very high for emergency repair of a ruptured aneurysm (greater than 50
percent).
Management of the patient with an AAA will be reviewed here. The clinical features and issues
related to diagnosis and screening are discussed elsewhere. (See "Epidemiology, clinical features,
and diagnosis of abdominal aortic aneurysm" and see "Screening for abdominal aortic aneurysm").
These and other early studies are not thought to completely reflect the natural history. Advanced
diagnostic techniques were not widely available, and the studies included more symptomatic large
aneurysms than smaller asymptomatic aneurysms.
Risk of rupture — The likelihood that an aneurysm will rupture is influenced by number of factors,
including aneurysm diameter, rate of expansion, and gender.
Aneurysm size — Aneurysm size is one of the strongest predictors of the risk of rupture, with risk
increasing markedly at aneurysm diameters greater than 5.5 cm (show figure 1) [2-9]. A statement
from the Joint Council of the American Association for Vascular Surgery and Society for Vascular
Surgery estimated the annual rupture risk according to AAA diameter [9]:
• Zero in aneurysms less than 4.0 cm in diameter