Gå direkt till huvudinnehållet

Aortaaneurysm

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Lokaliserad utvidgad del av aorta, vanligast i abdominala aorta. Antas bero på ateroskleros.
Förekomst:
I obduktionsmaterial föreligger aortaaneurysm hos 2–4 % vid ålder över 50–60 år.
Symtom:
Vanligtvis asymtomatiskt, men kan med tiden ge symtom till följd av tryck från aneurysmet. Vid ruptur uppstår snabbt magsmärtor och chock.
Kliniska fynd:
Eventuellt pulserande fyllnad i buken.
Diagnostik:
Verifieras och följs med ultraljud eller DT.
Behandling:
Förebyggande kirurgi vid diameter över 55 mm hos män och cirka 50 mm hos kvinnor eller expansion över 1 cm per år. 
  1. Esvs Guidelines Committee: Wanhainen A, Verzini F, Van Herzeele I et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019 Jan;57(1):8-93. doi: 10.1016/j.ejvs.2018.09.020. Epub 2018 Dec 5. Erratum in: Eur J Vasc Endovasc Surg. 2020 Mar;59(3):494. PMID: 30528142. PubMed  
  2. Riambau V, Böckler D, Brunkwall J et al. Editor's choice - management of descending thoracic aorta diseases: clinical practice guidelines of the European society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53: 4-52 PubMed  
  3. Johansson G, Markström U, Swedenborg J et al. Ruptured thoracic aortic aneurysms: A study of incidence and mortality. Journal of Vascular Surgery. Volume 21, Issue 6, June 1995, Pages 985-988. https://doi.org/10.1016/S0741-5214(95)70227-X
  4. Gunnarsson K, Wanhainen A, Björck M et al. Nationwide Study of Ruptured Abdominal Aortic Aneurysms During Twenty Years (1994-2013). Ann Surg. 2019 Aug 14. PMID: 31425332 PubMed  
  5. Detaint D, Michelena HI, Nkomo VT, Vahanian A, Jondeau G, Sarano ME. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy. Heart. 2014 Jan;100(2):126-34. doi: 10.1136/heartjnl-2013-304920. Epub 2013 Nov 19. PMID: 24254191. PubMed  
  6. Quintana RA, Taylor WR. Cellular Mechanisms of Aortic Aneurysm Formation. Circ Res. 2019 Feb 15;124(4):607-618. doi: 10.1161/CIRCRESAHA.118.313187. PMID: 30763207;
  7. Jacomelli J, Summers L, Stevenson A et al. Inequalities in abdominal aortic aneurysm screening in England: social deprivation and ethnicity. Eur J Vasc Endovasc Surg. 2017; 53: 837-843. PMID: 28416264 PubMed  
  8. Jahangir E, Lipworth L, Edwards T et al.Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study.J Epidemiol Comm Health. 2015; 69: 481-488. PMID: 25563744 PubMed  
  9. Wahlgren CM, Larsson E, Magnusson PK, Hultgren R, Swedenborg J. Genetic and environmental contributions to abdominal aortic aneurysm development in a twin population. J Vasc Surg. 2010 Jan;51(1):3-7; discussion 7. doi: 10.1016/j.jvs.2009.08.036. Epub 2009 Nov 24. PMID: 19939604. PubMed  
  10. Joergensen TM, Christensen K, Lindholt JS, Larsen LA, Green A, Houlind K. Editor's Choice - High Heritability of Liability to Abdominal Aortic Aneurysms: A Population Based Twin Study. Eur J Vasc Endovasc Surg. 2016 Jul;52(1):41-6. doi: 10.1016/j.ejvs.2016.03.012. Epub 2016 Apr 20. PMID: 27107486. PubMed  
  11. Singh S, Nautiyal A. Aortic Dissection and Aortic Aneurysms Associated with Fluoroquinolones: a Systematic Review and Meta-Analysis of Observational Studies. Am J Med 2017. pmid:28739200 PubMed  
  12. Dong YH, Chang CH, Wang JL et al. Association of Infections and Use of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection. JAMA Intern Med. 2020. PMID: 32897358. PubMed  
  13. Gopalakrishnan C, Bykov K, Fischer MA et al. Association of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection. JAMA Intern Med. 2020. PMID: 32897307 PubMed  
  14. Ahmed R, Ghoorah K, Kunadian V. Abdominal Aortic Aneurysms and Risk Factors for Adverse Events. Cardiol Rev. 2016 Mar-Apr;24(2):88-93. pmid: 25580705 PubMed  
  15. Spesamgruppen för kardiologi. Bukaortaaneurysm (BAA) utan symtom. Viss. Hämtad 2020-10-12. www.viss.nu  
  16. Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician. 2015 Apr 15;91(8):538-43.
  17. Johansson M, Zahl PH, Siersma V, Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study. Lancet. 2018 Jun 16;391(10138):2441-2447. PMID: 29916384 PubMed  
  18. Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ 2005; 330: 750. British Medical Journal  
  19. Ehlers L, Overvad K, Sørensen J, Christensen S, Bech M, Kjølby M. Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm. BMJ 2009; 338: b2243. BMJ (DOI)  
  20. Metcalfe D, Holt PJE, Thompson MM. The management of abdominal aortic aneurysms. BMJ 2011; 342: d1384. BMJ (DOI)  
  21. Thompson SG, Ashton HA, Gao L, et al. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ 2009; 338: b2307. BMJ (DOI)  
  22. Guirguis-Blake JM, Beil TL, Senger CA, et al. Primary Care Screening for Abdominal Aortic Aneurysm Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 322: 2219-38. doi:10.1001/jama.2019.17021 DOI  
  23. Baxter BT, Matsumura J, Curci JA, McBride R, Larson L, Blackwelder W, Lam D, Wijesinha M, Terrin M; N-TA3CT Investigators. Effect of Doxycycline on Aneurysm Growth Among Patients With Small Infrarenal Abdominal Aortic Aneurysms: A Randomized Clinical Trial. JAMA. 2020 May 26;323(20):2029-2038. doi: 10.1001/jama.2020.5230. PMID: 32453369 PubMed  
  24. Rughani G, Robertson L, Clarke M. Medical treatment for small abdominal aortic aneurysms. Cochrane Database Syst Rev 2012 Sep 12; 9: CD009536 Cochrane (DOI)  
  25. Talvitie M, Stenman M, Roy J, Leander K, Hultgren R. Sex Differences in Rupture Risk and Mortality in Untreated Patients With Intact Abdominal Aortic Aneurysms. J Am Heart Assoc. 2021;10(5):e019592. PMID:33619974. PubMed  
  26. Ali MU, Fitzpatrick-Lewis D, Miller J, Warren R, Kenny M, Sherifali D, Raina P. Screening for abdominal aortic aneurysm in asymptomatic adults. J Vasc Surg. 2016 Dec;64(6):1855-1868. doi: 10.1016/j.jvs.2016.05.101. PMID: 27871502. PubMed  
  27. Schlösser FJ, Vaartjes I, van der Heiden GJ, et al. Mortality after elective abdominal aortic aneurysm repair. Ann Surg 2010; 25: 158-64. PubMed  
  28. Schermerhorn ML, O'Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysm in the medicare population. N Engl J Med 2008; 358: 464-74. New England Journal of Medicine  
  29. Grootenboer N, van Sambeek MR, Arends LR, Hendriks JM, Hunink MG, Bosch JL. Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm. Br J Surg 2010; 97: 1169-79. PubMed  
  • Athena Adeli, legitimerad läkare, Karolinska Institutet

Tidigare sakkunniga

  • Anders Gottsäter, docent och överläkare, Kärlkliniken, Skånes universitetssjukhus