Aortic Aneurysms: Clinical Guidelines for Primary Care Physicians
Aortic aneurysms (AA) are permanent, localized abnormal dilation of the wall of the aorta, the largest artery in the body, occurring as a result of medial degeneration of the arterial wall, generally, as a result of increased aortic hypertension or genetic predisposition. Risk factors for AAs are similar to those of other cardiovascular diseases. Tobacco use is strongly associated with aneurysm formation and dilation, and patients diagnosed with AA should be advised to stop smoking. An abdominal aorta with a diameter greater than 3.00 cm is generally considered aneurysmal. By convention, a thoracic aorta with a diameter greater than 4.50 cm is generally considered aneurysmal. No specific laboratory tests exist to diagnose an AA, and testing should be ordered supplementary to imaging studies. Dedicated imaging studies offer definitive identification or exclusion of potential AAs, but the imaging modality used is largely dependent upon patient-related factors. Patients with small aneurysms may be candidates for medical management, however, any patient with an aortic diameter greater than 5.00 - 5.50 cm should be referred for immediate surgical consultation. With the majority of AAs asymptomatic prior to rupture, it is important that primary care physicians understand how to properly evaluate and diagnose patients at risk for developing an AA as well as the short and long-term management of patients diagnosed with an AA.