Abdominal aortic aneurysm — Frequently asked questions (FAQ)
1) What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm is a permanent dilatation of the abdominal aorta with a diameter of 30 mm or more, or more than 50% greater than the diameter expected for the individual. It is more common in older men and smokers and is frequently identified incidentally during imaging examinations.
2) What are the main risk factors?
The main risk factors include older age, male sex, current or previous smoking, a family history of abdominal aortic aneurysm, hypertension, peripheral arterial disease and other manifestations of atherosclerosis.
3) When should screening be performed?
Screening is recommended primarily for men aged between 65 and 75 years with a history of smoking. It may also be considered in first-degree relatives of patients with an abdominal aortic aneurysm, women who smoke and have multiple risk factors, and patients with peripheral arterial disease.
4) What is the preferred examination for diagnosis and surveillance?
Abdominal ultrasound is the first-line examination for screening, diagnosis and surveillance. It is non-invasive, widely available and highly sensitive for detecting and monitoring the aneurysm.
5) When should the patient be referred to Vascular Surgery?
Referral should be considered when the aneurysm reaches the generally accepted thresholds for elective repair (≥55 mm in men or ≥50 mm in women), shows rapid growth or becomes symptomatic, particularly with abdominal or back pain or signs of distal embolisation.
6) How frequently should surveillance be performed?
The surveillance interval depends on the aneurysm diameter. In general, aneurysms measuring between 30 and 39 mm may be reassessed every 3 years, intermediate-sized aneurysms require annual surveillance, and aneurysms approaching the surgical thresholds should be monitored every 6 months.
7) What are the signs of possible rupture?
Sudden severe abdominal or back pain, hypotension, syncope or the presence of a pulsatile abdominal mass should raise suspicion of aneurysm rupture. This is a medical emergency requiring immediate hospital referral.
8) Does smoking cessation influence aneurysm progression?
Yes. Smoking is the main modifiable risk factor. Smoking cessation is associated with slower aneurysm growth and a reduced risk of rupture, making it one of the most important therapeutic measures for all patients.
9) Are statins indicated?
Although statins are not prescribed specifically to treat the aneurysm, they are frequently indicated because of the high cardiovascular risk of these patients. Some observational studies also suggest a potential benefit in reducing aneurysm progression.
10) Should antiplatelet therapy be prescribed solely because an aneurysm is present?
No. The presence of an abdominal aortic aneurysm is not, by itself, an indication for antiplatelet therapy. Its use should follow the usual cardiovascular indications, such as coronary artery disease, stroke or peripheral arterial disease.
11) Can metformin be used to reduce aneurysm growth?
Observational studies suggest an association between metformin use and slower aneurysm growth. However, there is currently insufficient evidence to recommend its use specifically for this purpose outside the usual indications for diabetes mellitus.
