eMedicine Specialties > Vascular Surgery > Medical Topics

Abdominal Aortic Aneurysm: Workup

Author: William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
Contributor Information and Disclosures

Updated: Oct 28, 2009

Workup

Laboratory Studies

  • CBC count with differential: This study is used to assess transfusion requirements and the possibility of infection.
  • Blood chemistries (including a renal and liver panel): Ascertain the integrity of renal and hepatic function to best manage the patient postoperatively and to assess operative risk.
  • Type and crossmatch blood: Prepare for the possibility of transfusion, including clotting factors and platelets.
  • Urinalysis: Because synthetic material is used in the intervention, assess and eliminate potential foci of infection preoperatively.
  • Arterial blood gases: Assess pulmonary function preoperatively in order to determine operative risk and postoperative care. Patients who can climb a flight of stairs without excessive shortness of breath generally do well. If in doubt about the patient's pulmonary status, blood gas tests and pulmonary function tests are helpful.

Imaging Studies

  • Chest radiography: This study is used to gain a preliminary assessment of the status of the heart and lungs. Concurrent pulmonary or cardiac disease may need to be addressed prior to treating the aneurysm.
  • Abdominal ultrasonography: This study is used as a preliminary determination of aneurysm presence, size, and extent. It is a cost-effective modality for monitoring patients whose aneurysms are too small for surgical intervention.
  • CT scanning: This study helps more clearly define the anatomy of the aneurysm and other intra-abdominal pathologies.
    • Although sizing the aneurysm is important, the anatomic relationships important to surgery are also determined, ie, location of the renal arteries, length of the aortic neck, condition of the iliac arteries, and anatomic variants such as a retroaortic left renal vein or horseshoe kidney.
    • Enhanced spiral CT scanning of the abdomen and pelvis with multiplanar reconstruction and CT angiography is the test of choice for preoperative evaluation for open and endovascular repair (see Image 8). Nonenhanced CT scanning is used to size aneurysms.
Enhanced spiral CT scans with multiplanar reconst...

Enhanced spiral CT scans with multiplanar reconstruction and a CT angiogram.

[ CLOSE WINDOW ]
Enhanced spiral CT scans with multiplanar reconst...

Enhanced spiral CT scans with multiplanar reconstruction and a CT angiogram.

  • Magnetic resonance angiography: This imaging modality is quickly replacing the traditional angiographic assessment of aneurysms. The study provides excellent anatomical definition and 3-dimensional assessment of the problem. Gadolinium-enhanced magnetic resonance angiography can provide excellent images, even though regional variations in quality are reported.
  • Angiography: This imaging modality remains the criterion standard for the diagnosis of AAA, and it is indicated in the presence of associated renal or visceral involvement, peripheral occlusive disease, or aneurysmal disease. Angiography is also essential with any renal abnormality (eg, horseshoe kidney, pelvic kidney). See Image 9.
Angiography is used to diagnose the renal area. I...

Angiography is used to diagnose the renal area. In this instance, an endoleak represented continued pressurization of the sac.

[ CLOSE WINDOW ]
Angiography is used to diagnose the renal area. I...

Angiography is used to diagnose the renal area. In this instance, an endoleak represented continued pressurization of the sac.

  • Echocardiography: Because of the fluid shift involved during the operative repair of AAA, cardiac function should be assessed using echocardiography. By ascertaining the ejection fraction of the patient, the operative intervention can be planned and cardiac protective measures can be instituted as needed. This study is particularly indicated in patients with a history of CHF or known cardiac enlargement.

Other Tests

  • Pulmonary function tests: Assessment of pulmonary function is of paramount importance in these patients. Because surgical intervention requires an abdominal incision, preoperative assessment of the patient's pulmonary status allows for tailored postoperative care.
  • Electrocardiography: Assess cardiac status in all patients with vascular disease. If one vascular bed is involved with an atherosclerotic process, then consider that others also may be involved. Electrocardiography findings provide a baseline assessment of cardiac rhythm and old disease processes.
  • Stress test: A stress test can be performed to uncover unsuspected cardiac ischemia. Significant coronary disease may need to be addressed before the AAA can be repaired.

Histologic Findings

Abdominal aortic aneurysms (AAAs) contain a chronic inflammatory infiltrate and neovascularity of varying degrees. Inflammatory AAAs may contain germinal centers.

More on Abdominal Aortic Aneurysm

Overview: Abdominal Aortic Aneurysm
Workup: Abdominal Aortic Aneurysm
Treatment: Abdominal Aortic Aneurysm
Follow-up: Abdominal Aortic Aneurysm
Multimedia: Abdominal Aortic Aneurysm
References
[ CLOSE WINDOW ]

References

  1. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. Nov 1991;5(6):491-9. [Medline].

  2. Lederle FA, Johnson GR, Wilson SE, Chute EP, Littooy FN, Bandyk D. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. Mar 15 1997;126(6):441-9. [Medline].

  3. Majumder PP, St Jean PL, Ferrell RE, Webster MW, Steed DL. On the inheritance of abdominal aortic aneurysm. Am J Hum Genet. Jan 1991;48(1):164-70. [Medline].

  4. Tilson MD, Ozsvath KJ, Hirose H, Xia S. A genetic basis for autoimmune manifestations in the abdominal aortic aneurysm resides in the MHC class II locus DR-beta-1. Ann N Y Acad Sci. Nov 18 1996;800:208-15. [Medline].

  5. Wassef M, Baxter BT, Chisholm RL, Dalman RL, Fillinger MF, Heinecke J. Pathogenesis of abdominal aortic aneurysms: a multidisciplinary research program supported by the National Heart, Lung, and Blood Institute. J Vasc Surg. Oct 2001;34(4):730-8. [Medline].

  6. Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. May 2003;37(5):1106-17. [Medline].

  7. The UK Small Aneurysm Trial Participants. Mortality results for randomized controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet. 1998;353:1649-55.

  8. Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. May 9 2002;346(19):1437-44. [Medline].

  9. Tan JW, Yeo KK, Laird JR. Food and Drug Administration-approved endovascular repair devices for abdominal aortic aneurysms: a review. J Vasc Interv Radiol. Jun 2008;19(6 Suppl):S9-S17. [Medline].

  10. Ailawadi G, Eliason JL, Upchurch GR Jr. Current concepts in the pathogenesis of abdominal aortic aneurysm. J Vasc Surg. Sep 2003;38(3):584-8. [Medline].

  11. Baron JF, Mundler O, Bertrand M, Vicaut E, Barré E, Godet G. Dipyridamole-thallium scintigraphy and gated radionuclide angiography to assess cardiac risk before abdominal aortic surgery. N Engl J Med. Mar 10 1994;330(10):663-9. [Medline].

  12. Bender JS, Smith-Meek MA, Jones CE. Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: results of a prospective, randomized trial. Ann Surg. Sep 1997;226(3):229-36; discussion 236-7. [Medline].

  13. Bickerstaff LK, Hollier LH, Van Peenen HJ, Melton LJ 3rd, Pairolero PC, Cherry KJ. Abdominal aortic aneurysms: the changing natural history. J Vasc Surg. Jan 1984;1(1):6-12. [Medline].

  14. Brady AR, Fowkes FG, Greenhalgh RM, Powell JT, Ruckley CV, Thompson SG. Risk factors for postoperative death following elective surgical repair of abdominal aortic aneurysm: results from the UK Small Aneurysm Trial. On behalf of the UK Small Aneurysm Trial participants. Br J Surg. Jun 2000;87(6):742-9. [Medline].

  15. Breckwoldt WL, Mackey WC, O'Donnell TF Jr. The economic implications of high-risk abdominal aortic aneurysms. J Vasc Surg. Jun 1991;13(6):798-803; discussion 803-4. [Medline].

  16. Brown PM, Pattenden R, Gutelius JR. The selective management of small abdominal aortic aneurysms: the Kingston study. J Vasc Surg. Jan 1992;15(1):21-5; discussion 25-7. [Medline].

  17. Brown PM, Pattenden R, Vernooy C, Zelt DT, Gutelius JR. Selective management of abdominal aortic aneurysms in a prospective measurement program. J Vasc Surg. Feb 1996;23(2):213-20; discussion 221-2. [Medline].

  18. Bunt TJ. Synthetic vascular graft infections. I. Graft infections. Surgery. Jun 1983;93(6):733-46. [Medline].

  19. Bunt TJ. Synthetic vascular graft infections. II. Graft-enteric erosions and graft-enteric fistulas. Surgery. Jul 1983;94(1):1-9. [Medline].

  20. Chang JB, Stein TA, Liu JP, Dunn ME. Risk factors associated with rapid growth of small abdominal aortic aneurysms. Surgery. Feb 1997;121(2):117-22. [Medline].

  21. Crawford ES, Cohen ES. Aortic aneurysm: a multifocal disease. Presidential address. Arch Surg. Nov 1982;117(11):1393-400. [Medline].

  22. Crawford ES, Saleh SA, Babb JW 3rd, Glaeser DH, Vaccaro PS, Silvers A. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period. Ann Surg. Jun 1981;193(6):699-709. [Medline].

  23. Cronenwett JL, Sargent SK, Wall MH, Hawkes ML, Freeman DH, Dain BJ. Variables that affect the expansion rate and outcome of small abdominal aortic aneurysms. J Vasc Surg. Feb 1990;11(2):260-8; discussion 268-9. [Medline].

  24. Davies MJ. Aortic aneurysm formation: lessons from human studies and experimental models. Circulation. Jul 21 1998;98(3):193-5. [Medline].

  25. Ernst CB. Abdominal aortic aneurysm. N Engl J Med. Apr 22 1993;328(16):1167-72. [Medline].

  26. Frame PS, Fryback DG, Patterson C. Screening for abdominal aortic aneurysm in men ages 60 to 80 years. A cost-effectiveness analysis. Ann Intern Med. Sep 1 1993;119(5):411-6. [Medline].

  27. Gadowski GR, Pilcher DB, Ricci MA. Abdominal aortic aneurysm expansion rate: effect of size and beta- adrenergic blockade. J Vasc Surg. Apr 1994;19(4):727-31. [Medline].

  28. Gillum RF. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol. Nov 1995;48(11):1289-98. [Medline].

  29. Gomes MN, Choyke PL, Wallace RB. Infected aortic aneurysms. A changing entity. Ann Surg. May 1992;215(5):435-42. [Medline].

  30. Grange JJ, Davis V, Baxter BT. Pathogenesis of abdominal aortic aneurysm: an update and look toward the future. Cardiovasc Surg. Jun 1997;5(3):256-65. [Medline].

  31. Greenhalgh RM, Forbes JF, Fowkes FG, Powel JT, Ruckley CV, Brady AR. Early elective open surgical repair of small abdominal aortic aneurysms is not recommended: results of the UK Small Aneurysm Trial. Steering Committee. Eur J Vasc Endovasc Surg. Dec 1998;16(6):462-4. [Medline].

  32. Gregory AK, Yin NX, Capella J, Xia S, Newman KM, Tilson MD. Features of autoimmunity in the abdominal aortic aneurysm. Arch Surg. Jan 1996;131(1):85-8. [Medline].

  33. Guirguis EM, Barber GG. The natural history of abdominal aortic aneurysms. Am J Surg. Nov 1991;162(5):481-3. [Medline].

  34. Hallett JW Jr, Marshall DM, Petterson TM, Gray DT, Bower TC, Cherry KJ Jr. Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience. J Vasc Surg. Feb 1997;25(2):277-84; discussion 285-6. [Medline].

  35. Johnston KW, Hertzer NR, Rutherford RB, et al. Joint Council guidelines for disclosure of conflict of interest. J Vasc Surg. Jul 2000;32(1):213-5. [Medline].

  36. Laheij RJ, Buth J, Harris PL, Moll FL, Stelter WJ, Verhoeven EL. Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR). Br J Surg. Dec 2000;87(12):1666-73. [Medline].

  37. Lederle FA, Johnson GR, Wilson SE, Chute EP, Hye RJ, Makaroun MS. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med. May 22 2000;160(10):1425-30. [Medline].

  38. May J, White GH, Yu W, Waugh R, Stephen MS, Chaufour X. Endovascular grafting for abdominal aortic aneurysms: changing incidence and indication for conversion to open operation. Cardiovasc Surg. Apr 1998;6(2):194-7. [Medline].

  39. Moore WS, Brewster DC, Bernhard VM. Aorto-uni-iliac endograft for complex aortoiliac aneurysms compared with tube/bifurcation endografts: results of the EVT/Guidant trials. J Vasc Surg. Feb 2001;33(2 Suppl):S11-20. [Medline].

  40. Ouriel K, Geary K, Green RM, Fiore W, Geary JE, DeWeese JA. Factors determining survival after ruptured aortic aneurysm: the hospital, the surgeon, and the patient. J Vasc Surg. Apr 1990;11(4):493-6. [Medline].

  41. Ouriel K, Green RM, Donayre C, Shortell CK, Elliott J, DeWeese JA. An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture. J Vasc Surg. Jan 1992;15(1):12-8; discussion 19-20. [Medline].

  42. Raghavan ML, Vorp DA, Federle MP, Makaroun MS, Webster MW. Wall stress distribution on three-dimensionally reconstructed models of human abdominal aortic aneurysm. J Vasc Surg. Apr 2000;31(4):760-9. [Medline].

  43. Rasmussen TE, Hallett JW Jr. Inflammatory aortic aneurysms. A clinical review with new perspectives in pathogenesis. Ann Surg. Feb 1997;225(2):155-64. [Medline].

  44. Rutherford RB, Krupski WC. Current status of open versus endovascular stent-graft repair of abdominal aortic aneurysm. J Vasc Surg. May 2004;39(5):1129-39. [Medline].

  45. Stella A, Gargiulo M, Faggioli GL, Bertoni F, Cappello I, Brusori S. Postoperative course of inflammatory abdominal aortic aneurysms. Ann Vasc Surg. May 1993;7(3):229-38. [Medline].

  46. Tung WS, Lee JK, Thompson RW. Simultaneous analysis of 1176 gene products in normal human aorta and abdominal aortic aneurysms using a membrane-based complementary DNA expression array. J Vasc Surg. Jul 2001;34(1):143-50. [Medline].

  47. Vohra R, Reid D, Groome J, Abdool-Carrim AT, Pollock JG. Long-term survival in patients undergoing resection of abdominal aortic aneurysm. Ann Vasc Surg. Sep 1990;4(5):460-5. [Medline].

  48. Vorp DA, Raghavan ML, Webster MW. Mechanical wall stress in abdominal aortic aneurysm: influence of diameter and asymmetry. J Vasc Surg. Apr 1998;27(4):632-9. [Medline].

  49. White GH, May J, McGahan T, Yu W, Waugh RC, Stephen MS. Historic control comparison of outcome for matched groups of patients undergoing endoluminal versus open repair of abdominal aortic aneurysms. J Vasc Surg. Feb 1996;23(2):201-11; discussion 211-2. [Medline].

  50. Wills A, Thompson MM, Crowther M, Sayers RD, Bell PR. Pathogenesis of abdominal aortic aneurysms--cellular and biochemical mechanisms. Eur J Vasc Endovasc Surg. Nov 1996;12(4):391-400. [Medline].

  51. Zarins CK, Wolf YG, Lee WA, Hill BB, Olcott C IV, Harris EJ. Will endovascular repair replace open surgery for abdominal aortic aneurysm repair?. Ann Surg. Oct 2000;232(4):501-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

abdominal aortic aneurysm, abdominal aortic aneurysms, aortic ectasia, arteriomegaly, diffuse arterial enlargement, atherosclerotic vascular disease, Marfan's syndrome, Marfan syndrome, AAA, aortic rupture, atherosclerosis, Dacron, Gore-Tex

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Lawrence Kaufman, MD, Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine
Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Travis J Phifer, MD, Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.