A Noncompliant Construction Worker With a Pulsating Abdomen

Muthunivas Muthuraj; Rahul R. Borra; Panagiotis Iakovidis, MD


November 22, 2021

Because this patient's distal aorta is 4.4 cm in diameter, he is at low risk for AAA rupture and therefore can be observed for the time being, with a follow-up ultrasound every 6 months to monitor any changes to the aneurysm. To reduce new thrombus formation and break down the current thrombus within the aneurysm, 81 mg of aspirin once a day was prescribed. In addition, the patient was again advised to quit smoking as soon as possible because smoking increases the growth rate of the aneurysm as well as the likelihood of rupture. Finally, the patient was strongly encouraged to make small dietary changes (such as decreasing his consumption of red meat) and adhere to his medication regimen, in order to control his lipid levels.

If this patient's aneurysm had been larger than 5.5 cm, the likelihood of surgical intervention would increase. Surgery would also be considered if the aneurysm grows more than 0.5 cm within a 6-month period.[6] Studies have shown that patients with an AAA of between 4 cm and 5.5 cm have a 65% chance of requiring surgery within the next 5 years.[7]

The two interventions used to treat AAA are endovascular repair and surgical repair. Endovascular repair of an AAA involves placing a stent graft within the aneurysm via a catheter and expanding the stent. Once the stent is expanded, blood flows from the aorta through the stent, preventing any accumulation of blood within the walls of the aneurysm. This procedure is less invasive than surgical repair and decreases the length of hospital stay but lacks the long-term benefits of surgical intervention. Surgical repair involves the placement of a graft within the weakened sections of the aneurysmal walls to allow stable blood flow.[4]


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