Abstract

Despite declining incidence and mortality rates in many countries, the abdominal aortic aneurysm (AAA) continues to represent a life-threatening cardiovascular condition with an overall prevalence of about 2–3% in the industrialized world. While the risk of AAA development is considerably higher for men of advanced age with a history of smoking, screening programs serve to detect the often asymptomatic condition and prevent aortic rupture with an associated death rate of up to 80%. This review summarizes the current knowledge on identified risk factors, the multifactorial process of pathogenesis, as well as the latest advances in medical treatment and surgical repair to provide a perspective for AAA management.

Highlights

  • An aneurysm is a persistent and localized weakening and dilation of a blood vessel, typically an artery [1]

  • An analysis of historical and current laboratory data of patients from 12 years before their initial abdominal aortic aneurysm (AAA) diagnoses found that prior elevated total cholesterol (TC), low-density lipoprotein (LDL), and triglyceride levels were significantly associated with current AAA (ORs 1.9, 2.3, and 1.9, respectively) [77]

  • Two meta-analyses found conflicting results, with one confirming that increased LDL levels are associated with AAA presence [121], while the other found no such association for LDL, but found a significant effect on AAA development for elevated total cholesterol levels [122]

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Summary

Introduction

An aneurysm is a persistent and localized weakening and dilation of a blood vessel, typically an artery [1]. The most commonly used definition is a maximum infrarenal abdominal aortic diameter of ≥30 mm, measured by ultrasonography or computed tomography angiography (CTA) [4,5]. This threshold is based on measurements of healthy infrarenal aortic diameters and is usually more than two standard deviations above the mean diameter of 17.9–19.3 mm for men [6,7]. A dilation should be considered aneurysmal when this ratio exceeds 1.5 [1,8] This definition might be more useful for women, whose infrarenal aortic diameters measure a mean of.

Epidemiology
Clinical Presentation and Course of Disease
AAA Growth Rate
Aneurysm Rupture
Influence of Age and Sex
Ethnicity and Socioeconomic Factors
Family History and Genetic Influences
Smoking
Atherosclerosis and Cardiovascular Diseases
Arterial Hypertension and Dyslipidemia
Obesity and Lifestyle Habits
The Role of Diabetes Mellitus
Diagnosis and Management
Screening Programs
Imaging Techniques
Management of Small AAAs
Control of Cardiovascular Risk
Pharmacological Approaches to Limit AAA Growth
Surgical Treatment
Open Surgical Repair
Endovascular Aneurysm Repair
Comparison of Surgical Methods
Outcome of Elective AAA Repair
Management of the Ruptured AAA
Pathogenesis
Intraluminal Thrombosis and Biomechanical Aspects
Oxidative Stress and VSMC Apoptosis
Proteolysis
Inflammation
Monocytes and Macrophages in AAA
Neutrophils in AAA
Findings
Conclusions
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