| Definition |
Localized dilation of abdominal aorta >3cm |
Tear in aortic wall creating false lumen |
| Risk Factors |
Smoking (most important), male, hypertension, age >65, family history |
Hypertension (most important), Marfan syndrome, bicuspid valve, pregnancy |
| Pathophysiology |
Progressive weakening of arterial wall due to elastin degradation and inflammation; atherosclerosis leads to oxidative stress and matrix metalloproteinase activation |
Intimal tear allows blood to enter media, creating false lumen; can be triggered by hypertensive crisis or inherited connective tissue disorders |
| Onset |
Gradual |
Sudden, acute |
| Pain |
Usually asymptomatic; may have dull abdominal/back pain |
Severe, tearing chest/back pain; migrating |
| Physical Exam |
Pulsatile abdominal mass |
Unequal pulses, BP differences between arms |
| Complications |
Rupture with hemorrhagic shock |
Organ ischemia, tamponade, aortic rupture |
| Imaging |
Ultrasound, CT with contrast |
CT angiogram, TEE |
| Treatment |
Endovascular repair (EVAR) or open surgery if >5.5cm |
Emergency surgery (Type A), medical management (Type B) |
| Mortality |
80% if ruptured; 5% with elective repair |
50% at 48h without treatment (Type A) |