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Abdominal Aortic Aneurysm (AAA)

Abdominal Aortic Aneurysm (AAA) is a serious condition where the lower part of the aorta (the body's main artery that carries blood from the heart through the abdomen) weakens and bulges outward like a balloon. If it grows large enough, it can rupture, causing life-threatening internal bleeding.
Causes and Risk Factors:
The exact cause isn't always clear, but the aortic wall weakens over time due to factors like:
  • Atherosclerosis (hardening of the arteries, the most common cause)
  • Smoking (strongest modifiable risk factor)
  • Advanced age (most common in men over 65)
  • Male sex (4–6 times more common in men)
  • Family history (15–25% have a relative with AAA)
  • High blood pressure, high cholesterol, and certain connective tissue disorders (e.g., Marfan syndrome)
Symptoms: Most AAAs grow slowly and cause no symptoms until they become large or rupture (often called the "silent killer"). When symptoms do occur, they may include:
  • Pulsing sensation in the abdomen
  • Deep, constant pain in the abdomen, lower back, or groin
  • If it ruptures: Sudden, severe abdominal or back pain, low blood pressure, fainting — this is a medical emergency with high mortality (up to 85–90% if it ruptures outside hospital).

Diagnosis and Screening:
Often found incidentally during tests for other conditions. The gold standard is abdominal ultrasound (quick, non-invasive). Screening is recommended for high-risk groups, such as men aged 65–75 who have ever smoked (per U.S. guidelines like USPSTF and Medicare coverage).
Current guidelines (e.g., 2022 ACC/AHA, 2024 ESVS, and 2024 ESC updates) emphasize ultrasound screening in at-risk populations.

Treatment:
Depends on size, growth rate, and symptoms:
  • Small AAAs (<5.0–5.5 cm): Regular monitoring (surveillance with ultrasound/CT every 6–12 months), lifestyle changes (quit smoking, control BP/cholesterol), and medications (e.g., statins, blood pressure control).
  • Large or symptomatic AAAs: Repair is recommended when diameter reaches ≥5.5 cm in men or ≥5.0 cm in women (or faster growth >0.5 cm/year).
    • Endovascular Aneurysm Repair (EVAR): Less invasive; a stent graft is placed via catheter through the groin arteries.