Abdominal Aortic Aneurysm – Exploding in Silence

Abdominal aortic aneurysm is the most common type of aortic aneurysm in the human body. It is clinically defined as an abdominal aortic aneurysm when the maximum diameter of the abdominal aorta exceeds 3 cm. The incidence in the elderly male population in Western countries is approximately 4-9%, with 95% of abdominal aortic aneurysms located at the level of the infrarenal artery. With the aging of the society and the update of various new detection methods, its incidence has a tendency to increase year by year. Epidemiological surveys suggest that advanced age (≥65 years), male, smoking history, family history, hypertension, and atherosclerotic disease (coronary artery disease, hypercholesterolemia) are risk factors for abdominal aortic aneurysm. Approximately 9,000 patients die from abdominal aortic aneurysms each year in the United States. Most patients with abdominal aortic aneurysms are asymptomatic and remain “silent” for long periods of time, mostly detected during physical examinations. If left untreated, one-third of patients will “explode in silence” and have a ruptured aneurysm, with a 10-25% success rate in resuscitation. Sudden and severe abdominal pain is often a characteristic sign of abdominal aortic aneurysm rupture or acute dilatation and is a strong indication for emergency intervention. The clinical diagnosis of abdominal aortic aneurysm is relatively easy and is usually made by history and physical examination. Diagnosis can be confirmed by ultrasound, CT, and MRI. It has been found that for abdominal aortic aneurysms less than 5.5 cm in diameter, the rate of aneurysm expansion is 2.6 mm/year and the annual rupture rate is less than 1%, so this “small” abdominal aortic aneurysm is safe for close observation and can be treated conservatively for the time being. Unless the aneurysm grows >1 cm/year or symptoms such as abdominal pain develop. For abdominal aortic aneurysms >6 cm in diameter, the annual rupture rate is found to increase to 25% for the average patient. Therefore, most scholars believe that therapeutic intervention is required for aneurysms >5.5 cm in diameter, regardless of the presence of symptoms. Therapeutic interventions are divided into conventional surgical procedures and endoluminal stent repair of the aorta. For patients of advanced age, with many complications and high surgical risk who must be intervened, endoluminal stent repair is preferred if the indications are appropriate. It is less traumatic, has a definite effect, and has a faster recovery.