Clinical Presentation

Inflammatory abdominal aortic aneurysms occur predominantly in males in the 5th and 6th decades of life. The male to female ratio ranges from 15-6.5:1. Risk factors for atherosclerosis and the association with coronary artery (46-55%) and peripheral vascular disease (24%) occur with the same frequency as in patients with noninflammatory aneurysms. Nitecki et al has reported that patients with IAAA were more likely (17% versus 1.5%) to have a family history of aneurysms and currently be smoking cigarettes.

The clinical triad of chronic abdominal pain, weight loss, and an elevated eryth-rocyte sedimentation rate (ESR) in a patient with an abdominal aortic aneurysm is highly suggestive of an inflammatory aneurysm. Abdominal, flank, or back pain is present in up to 83% of patients with no ruptured IAAA compared to 14% of patients with noninflammatory aneurysms. Anorexia and weight loss occurs in 10-41% of patients with IAAA compared to 7-10% of those with AAA. The erythrocyte sedimentation rate is elevated in 40-88% of patients. The occurrence of fever and leukocytosis is quite variable (Table 16.1).

The most consistent finding on physical examination is the presence of a tender pulsatile mass. However, detection of a pulsatile mass is dependent on the size of the aneurysm as well as patient body habitus.

Table 16.1. Comparison of the frequency of symptoms between patients with IAAA and AAA

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