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Chapter: Clinical Cases in Anesthesia : Abdominal Aortic Aneurysm

What is the natural history of untreated abdominal aortic aneurysm (AAA)?

The natural history of all aneurysms is to expand in size.

What is the natural history of untreated abdominal aortic aneurysm (AAA)?

 

The natural history of all aneurysms is to expand in size. The tendency to rupture is primarily dependent on wall stress, which increases as the aneurysm enlarges, according to Laplace’s law:

 

Tension = Pressure × Radius/2 ×Wall Thickness


The average growth rate of aortic aneurysms is 0.4 cm per year. A follow-up study of high-risk patients reported an overall rupture rate of 3% and a surgical mortality (elective surgery for aneurysm size >6 cm or with symp-toms) of 4.9%. Thirty-four percent of mortalities were due to causes unrelated to the aneurysm. The 5-year survival for untreated AAA >6 cm was less than 10%, while the 5-year survival for untreated AAA <6 cm was 50%. Elevated diastolic blood pressure, aneurysm anteroposte-rior diameter >5 cm, and obstructive pulmonary disease were independent predictors of rupture. Predicted 5-year rupture rates varied from 2% when these risk factors were absent to 100% when all three risk factors were present.


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Clinical Cases in Anesthesia : Abdominal Aortic Aneurysm : What is the natural history of untreated abdominal aortic aneurysm (AAA)? |


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