What Clinical Factors Should Arouse Suspicion for Abdominal Aortic Aneurysm?

  • Cullen Clark
  • Joseph P. Martinez


Abdominal aortic aneurysm (AAA) is a serious degenerative vascular disease that affects 8% of the population. The majority of cases are asymptomatic until rupture, which harbors a high mortality rate. Early identification of symptomatic AAA and rupture can substantially improve mortality. Abdominal, back, and flank pain are common presenting symptoms, along with hypotension, syncope, and signs of distal hypoperfusion. Risk factors for rupture include aneurysm size, rate of growth, female sex, smoking, and family history of AAA. Physical exam has low sensitivity and can be misleading. Symptomatic AAA and rupture require emergent imaging and evaluation by a vascular specialist.


Abdominal aortic aneurysm AAA Rupture Risk factors Clinical presentation Physical exam Fistula 


  1. 1.
    Dua A, Kuy SR, Lee CJ, Upchurch GR, Desai SS. Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010. J Vasc Surg. 2014;59:1512–7.CrossRefGoogle Scholar
  2. 2.
    Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005;365:1577–89.CrossRefGoogle Scholar
  3. 3.
    Savolainen H, Novak J, Dick F, et al. Prevention of rupture of abdominal aortic aneurysm. Scand J Surg. 2010;99:217–20.CrossRefGoogle Scholar
  4. 4.
    Wanahainen A, Björck M, Boman K, Rutegård J, Bergqvist D. Influence of diagnostic criteria on the prevalence of abdominal aortic aneurysm. J Vasc Surg. 2001;34:229–35.CrossRefGoogle Scholar
  5. 5.
    Karkos CD, Mukhopadhyay U, Papakostas I, Ghosh J, Thompson GJL, Hughes R. Abdominal aortic aneurysm: the role of clinical examination and opportunistic detection. Eur J Vasc Endovasc Surg. 2000;19:299–303.CrossRefGoogle Scholar
  6. 6.
    Kent KC. Abdominal aortic aneurysms. N Engl J Med. 2014;371:2101–8.CrossRefGoogle Scholar
  7. 7.
    Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: a comprehensive review. Exp Clin Cardiol. 2011;16(1):11–5.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Sweeting MJ, Thompson SG, Brown LC, Powell JT. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg. 2012;99:655–65.CrossRefGoogle Scholar
  9. 9.
    Long B, Koyfman A. Vascular causes of Syncope: an emergency medicine review. J Emerg Med. 2017;53(3):1–11.CrossRefGoogle Scholar
  10. 10.
    Schmitz-Rixen T, Keese M, Hakimi M, Peters A, Böckler D. Ruptured abdominal aortic aneurysm - epidemiology, predisposing factors, and biology. Langenbeck's Arch Surg. 2016;401:275–88.CrossRefGoogle Scholar
  11. 11.
    Azhar BA, Patel SR, et al. Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis. J Endovasc Ther. 2014;21:568–75.CrossRefGoogle Scholar
  12. 12.
    Reed KC, Curtis LA. Aortic emergencies – part II: abdominal aneurysms and aortic trauma. Emerg Med Pract. 2006;8(3):1–20.Google Scholar
  13. 13.
    Chun KC, Teng KY, Chavez LA, Van Spyk EN, et al. Risk factors associated with the diagnosis of abdominal aortic aneurysm in patients screened at a regional Veterans Affairs health care system. Ann Vasc Surg. 2014;28:87–92.CrossRefGoogle Scholar
  14. 14.
    Vitturi BK, Frias A, Sementilli R, Racy MCJ, Caffaro RA, Pozzan G. Mycotic aneurysm with aortoduodenal fistula. Autops Case Rep. 2017;7(2):27–34.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Cullen Clark
    • 1
  • Joseph P. Martinez
    • 2
  1. 1.Emergency Medicine/Pediatrics ResidentLouisiana State University Health Sciences Center – New OrleansNew OrleansUSA
  2. 2.University of Maryland School of MedicineBaltimoreUSA

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