The management of abdominal aortic aneurysms

#### Summary points An abdominal aortic aneurysm (AAA) is a permanent dilation of the abdominal aorta greater than 3 cm in diameter (fig 1⇓). The natural course is one of progressive enlargement, and maximum aortic diameter is the strongest predictor of aneurysm rupture.1 w1 w2 The reported incidence of AAA is 4.9-9.9%,2 3 4 and mortality after rupture exceeds 80%, accounting for 8000 deaths annually in the United Kingdom.5 w3 Elective surgical repair has an operative mortality of 1-5% in the best centres,5 6 and several countries have implemented population screening programmes to reduce aneurysm related mortality. Fig 1 Preoperative computed tomography reconstruction of a 7.4 cm infrarenal abdominal aortic aneurysm This review considers the epidemiology and management of AAA using evidence from population studies, randomised controlled trials, meta-analyses, and published guidelines. #### Sources and selection criteria We searched PubMed for “abdominal aortic aneurysm” or “AAA” and used reference lists to identify key studies. We also consulted the Cochrane Library and consensus guidelines. The evidence base informing management of abdominal aortic aneurysms is relatively strong and we gave priority to large well designed randomised controlled trials, …