Aortenaneurysmen Abdominelle

As a rule aneurysms develop slowly from small to rupture imminent aneurysms. In 80% of cases they remain free of symptoms and in the majority of cases are therefore only discovered by chance. Women are 4-5 times less likely to be affected than men. Clinically relevant aneurysms with a diameter of more than 5 cm occur in 1% of males under 64 years old. The prevalence increases to 2-4% wih increasing age accompanied by increased comorbidity. The underlying reasons for the development of abdominal aortic aneurysms (AAA) are in most cases unclear. Aneurysms which occur in the infrarenal aorta and also in other locations often have a genetic background and an increased familial occurrence. The prognosis of a ruptured AAA is extremely poor with a hospital fatality rate of 55% and a total lethality of >80% because only some of the patients reach hospital alive. The letality associated with AAA can be reduced by establishing an ultrasound screening program by which AAA can be cost-effectively diagnosed with high reliability, sensitivity and specificity. Routine investigations should include the anterior-posterior measurement, determination of the longitudinal and transverse size as well as a topographical representation of the important efferent vessels. A medical, conservative therapy can be important for patients with small or medium sized aneurysms. The only valid measure against an impending AAA rupture is elective surgical treatment which can be carried out via an open repair of the abdominal aorta with a tube or bifurcated graft or by implantation of a stent-graft. Suitable patient selection and determination of the ideal timing for surgery are based on identification of patients with a special risk of rupture. The value of both procdures has not yet been clearly defined and requires a differentiated diagnosis of the indications.