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Clinical Crossroads
Clinician's Corner
November 11, 2009

A 66-Year-Old Man With an Abdominal Aortic AneurysmReview of Screening and Treatment

Author Affiliations

Author Affiliations: Dr Schermerhorn is Chief, Section of Endovascular Surgery, and Director of Clinical Research, Division of Vascular Surgery, Beth Israel Deaconess Medical Center, and Assistant Professor of Surgery, Harvard Medical School, Boston, Massachusetts.

JAMA. 2009;302(18):2015-2022. doi:10.1001/jama.2009.1502

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.