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- W2032252718 abstract "Since the middle of the 20th century, atherosclerosis has displaced syphilis as the most common cause of aortic aneurysm. Arteriosclerotic aneurysms occur with increasing frequency after the age of 50, reaching a peak incidence of 14% in males in the ninth decade. Males predominate in a 6:1 ratio, due to the earlier onset of aortic atherosclerosis in this sex. Blacks are affected less than half as frequently as whites. Although arteriosclerotic aneurysms are a consequence of atherosclerosis of the abdominal aorta, there is some evidence that hypertension and cigarette smoking may play an augmenting role. The development of an aneurysm of the abdominal aorta appears related to impaired nutrition to the media, the chief supporting layer, as a result of atherosclerotic thickening of the intima. The abdominal aorta is particularly subject to hemodynamic stress from the presence of a standing shock wave, the effect of collision of the normal pulse wave colliding with a reflection of the preceding pulse wave from the bifurcation. The pathologic aspects of atherosclerosis have been reviewed and its pathogenesis summarized as disturbances of the normal transmural movement of plasma constituents. A diagnosis of abdominal aneurysm is made by the finding of a well-defined pulsating mass in the epigastrium, usually projecting to the left. Expansile pulsation is particularly characteristic. Rupture of an aneurysm is suggested by the triad of excruciating abdominal pain, shock, and presence of an enlarging abdominal mass, but may simulate gastrointestinal, urinary tract, or other disease. Following rupture the mass may be fixed and tender, and an additional mass may develop in the left lower quadrant. Rupture is most common into the retroperitoneal tissues on the left side, less frequently the peritoneal cavity is involved, and only occasionally rupture occurs into the duodenum or the vena cava. Hemorrhagic discoloration of the skin overlying the hematoma is a sign occasionally encountered 3 or more days after rupture. Plain roentgenograms are often helpful in diagnosis, and may reveal a rim of calcification corresponding to the walls of the aneurysm. Ultrasonic aortography is a useful method for determining not only the diameter of an aneurysm but also for detecting enlargement. Autopsy studies indicate that about 28% of aneurysms rupture during the patient's lifetime. Small stable aneurysms seldom produce symptoms or rupture. Deep-seated pain, referrable to the aneurysm, should be regarded as evidence of enlargement. When rupture occurs, pain may become excruciating and is followed by shock in about half the cases. Treatment by aneurysmectomy with replacement by a homograft was developed in the early 1950s but was soon succeeded by use of the more durable synthetic prostheses. Tabulation of a number of reported series indicates an overall mortality from elective surgery of 16%, although the mortality has in recent years to less than 4% in an umber of surgical centers. Corresponding figures for the overall mortality of ruptured aneurysms, 54.5%, has been reduced to 32%–34%. Surgery is recommended for the symptomatic or expanding aneurysm. Rupture is an absolute indication for emergency surgery. Surgical indications for surgery on the small stable aneurysms are not clear; the decision must take into account the age of the patient, the mortality from surgery, the likelihood of rupture if the aneurysm is left alone, the presence of associated disease, and the useful life of the patient." @default.
- W2032252718 created "2016-06-24" @default.
- W2032252718 creator A5040086639 @default.
- W2032252718 creator A5055811194 @default.
- W2032252718 date "1973-09-01" @default.
- W2032252718 modified "2023-09-25" @default.
- W2032252718 title "Arteriosclerotic aneurysms of the abdominal aorta: A review" @default.
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