Abdominal aortic aneurysm: an illustrated narrative review

OBJECTIVE: To present a descriptive review of abdominal aortic aneurysm (AAA), including a review of risk factors for and case finding in AAA for chiropractors as primary contact health care practitioners. DATA SOURCES: Clinical and scientific literature identified through various sources including MEDLINE and citation tracking. DATA SYNTHESIS: Selective narrative review of relevant literature. RESULTS: AAA may be asymptomatic; however, back pain is a common presenting feature. Risk factors include male gender, increasing age, cigarette smoking, hypertension, chronic obstructive airway disease, claudication, and AAA in a first-degree relative. AAA should be considered in the differential diagnosis of older white patients, especially males, with low back pain. Estimated prevalence for AAAs in older males is in the order of 3% to 5%; rupture accounts for 1.7% of deaths in men aged 65 to 75 years. Elective surgical resection of AAAs (prior to rupture) offers a low operative mortality and good prognosis. CONCLUSION: AAA should be considered in the differential diagnosis of older patients presenting with low back pain and those with risk factors for AAA. Chiropractors, as primary contact health care practitioners, have a responsibility to refer patients suspected of having AAA for appropriate imaging and, where indicated, vascular surgical opinion.