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When symptoms or physical examination findings suggest AAA, abdominal ultrasonography or abdominal CT is usually the test of choice.Symptomatic patients should have immediate testing to make the diagnosis before catastrophic rupture.Enlargement often occurs in a stepwise pattern with periods of no growth observed.Other aneurysms enlarge exponentially, and, for unknown reasons, about 20% remain the same size indefinitely.Most abdominal aortic aneurysms are diagnosed incidentally when they are detected during physical examination or when abdominal ultrasonography, CT, or MRI is done for other reasons.

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Patients may be aware of an abnormally prominent abdominal pulsation.Although most aneurysms grow slowly without symptoms, rapidly enlarging aneurysms that are about to rupture can be tender.Rupture is most likely to occur on the left posterolateral wall 2 to 4 cm below the renal arteries.5.0 to 5.5 cm and if risk of perioperative complications is lower than estimated risk of rupture, AAA repair is indicated.Risk of rupture vs that of perioperative complications should be discussed frankly with the patient.

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