The abdominal aorta supplies all abdominal and pelvic viscera through its unpaired visceral branches (coeliac, SMA, IMA) and paired branches (renal, gonadal, lumbar arteries). Abdominal aortic aneurysm (AAA), fusiform dilatation to greater than 3 cm, affects 5% of men over 65. Elective repair (EVAR or open) is indicated for AAA greater than 5.5 cm to prevent rupture.
| Origin | Continuation of the thoracic aorta at the aortic hiatus of the diaphragm (T12) |
|---|---|
| Course | Descends anterior to the vertebral column, bifurcates into the common iliac arteries at the L4 level (just left of the umbilicus) |
| Branches |
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Ruptured AAA produces the classic triad of severe back or abdominal pain, hypotension, and a pulsatile abdominal mass. Emergency EVAR (if anatomy suitable) or open repair is mandatory. Elective EVAR involves deploying an endovascular graft through the femoral arteries to exclude the aneurysm sac from arterial pressure. The aortic bifurcation at L4 is the landmark for laparoscopic gynaecological surgery.
Aortic dilatation over 5.5 cm requiring elective EVAR or open repair to prevent rupture, ruptured AAA is a vascular emergency with 50% pre-hospital mortality.
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