Complex abdominal aortic aneurysms (CAAAs) present challenges for standard endovascular aneurysm repair (EVAR) due to their proximity to critical vessels. Advanced techniques like fenestrated and branched endovascular aortic repair (FB-EVAR) enable precise exclusion of the aneurysm while preserving organ perfusion. With continuous technological and procedural evolution, FB-EVAR has become a promising, minimally invasive alternative to open repair in appropriately selected patients. The published literature for single-center and multicenter studies evaluating the outcomes of FB-EVAR for CAAAs was searched using MEDLINE and Embase databases. Studies published between January 1st 2010 and January 1st 2025, in the English language which provided data on FB-EVAR of CAAAs with more than fifty reported cases were included. The average age of patients at the time of repair was 73.7 years, with males comprising the majority (85.8%). The most common aneurysm presentation was juxtarenal (47.8%), followed by pararenal (10.5%). Early mortality for the entire cohort was 2% and the most common early adverse event was acute kidney injury (6.2%). FB-EVAR for the treatment of CAAA has undergone significant evolution over the past decades and continues to advance, representing a promising and increasingly viable approach to this disease.

Polygenic risk scores (PRS) have demonstrated predictive validity across a range of cohorts and diseases, but quantifying their clinical utility remains a challenge. As PRS can be derived from a single biological sample and remains stable throughout life, we explore the potential of PRS to optimize existing screening programs. Via an integrated modelling approach, we quantify the potential clinical benefits arising from a knowledge of PRS across seven diseases with existing screening programs (abdominal aortic aneurysm, breast cancer, colorectal cancer, coronary artery disease, hypertension, prostate cancer, and type 2 diabetes). We identify individuals at high genetic risk (PRS OR>2) and very high genetic risk (PRS OR>3) and estimate the optimal screening ages for these genetically high-risk individuals, based on the equivalent risk to population-level risk at recommended screening ages. We then leverage published data on differential mortality and other outcomes, with and without screening-based interventions, to assess the potential benefits of tailoring screening age based on genetic risk. Very high risk individuals reach the risk level associated with usual starting screening age on average 10.8 years earlier, high risk individuals 8.9 years earlier and reduced risk individuals (OR<0.5) 16.8 years later. During this time, case enrichment (the ratio of the percentage of cases in the high PRS risk group and in the total population) in the high risk group is between 1.7 and 3.0, depending on the disease. Across all seven diseases, appropriate interventions following PRS-guided screening could reduce premature deaths in high-risk individuals by 23.3%. Knowledge of genetic risk, measured using PRS, has the potential to deliver substantial public health benefits when aggregated across conditions, and could reduce premature mortality by tailoring existing screening programs.

BackgroundAbdominal aortic aneurysm (AAA) refers to a lasting enlargement of the abdominal aorta. Senescence, a major risk factor of AAA, demonstrate positive connection with both the formation and rupture of aneurysms. Therefore, investigating the underlying pathogenic mechanisms of senescence in AAA and exploring relevant diagnostic and therapeutic targets is crucial.MethodsThree transcriptomic datasets related to AAA were obtained from the GEO database, and collection of genes associated with cellular senescence was obtained from MSigDB. Overlapping genes of differentially expressed genes (DEGs), module genes associated with AAA, and senescence-related gene sets were identified as senescence-related DEGs of AAA and subjected to further functional enrichment analysis. Distinct machine learning algorithms were subsequently utilized to screen for senescence-associated biomarkers and develop a diagnostic nomogram. In addition, the interaction between these biomarkers and immune components in the aneurysmal environment were revealed. Consensus clustering was subsequently applied to classify AAA into distinct subtypes. Finally, validation was performed using an AAA murine model.ResultsA total of 11 senescence-related DEGs in AAA were identified, which mainly involved with oxidative stress, inflammatory responses, and vascular smooth muscle cell activity. Following rigorous screening, IL6, ETS1, TDO2, and TBX2 were identified as diagnostic biomarkers for senescence-related DEGs of AAA. The nomogram constructed from these biomarkers demonstrated high discriminatory ability in the training cohort (AUC = 1), though this requires further validation in larger cohorts due to potential overfitting. Immune cell infiltration and single-cell analyses indicated that the expression of the diagnostic biomarkers is linked to various immune cell types. Consensus clustering identified two AAA subtypes, which exhibiting distinct expression patterns of senescence-related biomarkers. Finally, validation in an AAA murine model confirmed the expression changes of these senescence-related biomarkers in AAA.ConclusionThis study identified senescence-related biomarkers associated with AAA through transcriptomic public databases, revealing their potential functional mechanisms, relationships with immune cells, and associations with AAA subtypes. These results could offer novel candidate targets for both diagnostic and therapeutic strategies in AAA.

Background/Objectives: Coronary artery disease (CAD) is highly prevalent in patients undergoing vascular surgery and is a major determinant of postoperative morbidity and mortality. Preoperative anemia is a well-recognized risk factor for adverse outcomes, including major adverse cardiac events (MACEs), but its independent impact in patients with CAD undergoing abdominal aortic aneurysm (AAA) repair remains unclear. Methods: We conducted a retrospective cohort study of 410 consecutive patients undergoing open AAA repair at a tertiary vascular center between 2023 and 2025. Preoperative anemia was defined as hemoglobin &lt; 130 g/L and significant CAD as ≥70% luminal narrowing for non-left main disease or ≥50% for left main disease. The primary outcome was MACE (cardiovascular death, myocardial infarction, or stroke) during hospitalization. Baseline covariates included age, sex, diabetes mellitus (DM), chronic kidney disease (CKD), congestive heart failure (CHF), peripheral artery disease (PAD), and other relevant comorbidities. Multivariable logistic regression models were used to evaluate associations of anemia, CAD, and their interaction with MACE. Additionally, a composite risk group was created to examine MACE rates across mutually exclusive subgroups. Results: Among 410 patients, 314 (76.6%) had CAD and 116 (28.3%) had preoperative anemia. Overall, 67 patients (16.3%) experienced MACE. In the reduced model including only anemia and CAD, anemia remained a strong independent predictor of a MACE (OR 4.46, 95% CI 2.57–7.72, p &lt; 0.001), and CAD was also independently associated (OR 2.20, 95% CI 1.00–4.72, p = 0.044). In the full multivariable model adjusting for DM, CHF, CKD, PAD, and age, anemia was the strongest predictor (OR 4.53, 95% CI 2.49–8.26, p &lt; 0.001), while CAD showed a borderline association (OR 2.07, 95% CI 0.94–4.57, p = 0.071). Interaction analysis indicated no statistically significant modification in risk by the combination of anemia and CAD. The composite risk group variable was omitted due to collinearity with its components. Conclusions: Preoperative anemia, particularly in patients with CAD, is a significant and independent predictor of major adverse cardiac events following open AAA repair. These findings support the importance of early identification and correction of anemia before surgery to improve perioperative cardiac outcomes in this high-risk population.

Mid-term data on the Anaconda fenestrated stent-graft remain scarce in the literature. The aim of this study was to evaluate the efficacy and durability of its Z-stent-free proximal sealing system. All consecutive patients treated between January 2018 and May 2023 with the Anaconda Fenestrated stent-graft (Vascutek/Terumo, Scotland, UK) for complex abdominal aortic aneurysm (AAA) were retrospectively included in this monocentric study. The primary outcome was the occurrence of type Ia endoleak (EL). The secondary outcome was the evolution of the proximal sealing zone (PSZ), defined as proximal neck dilatation (PND) ≥3 mm, stent-graft migration (>10 mm), or the need for PSZ-related reintervention. Effective oversizing (OS) was calculated from the nominal stent-graft diameter and the mean aortic diameter at the PNR level on postoperative computed angiography (CT) angiography. A total of 111 patients were included (mean age 72±7.6 years, 86% male) with 69 juxta renal aneurysms (62.2%), 23 para-renal aneurysms (20.7%), and 19 proximal EL after EVAR (17.1%). The mean follow-up was 28.1±16.2 months. No primary type Ia EL was observed at discharge. During follow-up, 1 patient (<1%) developed a secondary type Ia EL, which was successfully managed with the placement of an aortic cuff. The PND was observed in 40 patients (36%), while significant stent-graft migration was observed in 1 patient (0.9%) without any impact on proximal sealing or bridging-stents. Effective OS was the only independent predictor of PND in the multivariable analysis (odds ratio [OR]=1.193; 95% confidence interval [CI]= 1.104-1.288; p<0.001). Seven patients (6.3%) underwent prophylactic PSZ-related reintervention, at a mean interval of 26.4±16.9 months following the index procedure, to prevent the occurrence of a type Ia EL. The proximal sealing system of the Anaconda fenestrated stent-graft's demonstrates encouraging mid-term performance, with a low incidence of type Ia EL observed over more than 2 years of follow-up. The PND related to stent-graft OS is common but generally stabilizes after the first year. Beyond this point, any progression should be attributed to the underlying aortic disease. In such cases, proximal extension of the sealing zone can be performed with satisfactory outcomes.Clinical ImpactThis study provides the first dedicated mid-term evaluation of the proximal sealing system of the Anaconda® fenestrated stent-graft in complex abdominal aortic aneurysms. When implanted in a healthy supraceliac landing zone with adequate effective oversizing, the device offers durable proximal sealing with a low incidence of type Ia endoleak. These findings support confident use of the Anaconda® platform in challenging anatomies, while emphasizing the importance of careful deployment to avoid use of the repositioning system and the associated risk of ring tilting. The study also highlights that early proximal neck dilatation is common but usually stabilizes, justifying tailored surveillance and allowing prophylactic proximal extension when necessary.

The Dutch healthcare system is strained due to population aging, workforce shortages, and rising costs. The Integral Care Act introduced the concept of appropriate care, in which value-based choices are central. Frail elderly patients with an abdominal aortic aneurysm (AAA) have worse outcomes after surgery. Clear guidelines for this group are lacking, while appropriate care could provide benefits. A conservative approach by refraining from surgery, despite an indication for intervention, may be a realistic option aligned with the do no further harm principle. Two measures can support this choice: refraining from further increasing volume thresholds, as this may have counterproductive effects, and providing appropriate reimbursement for the complex preoperative assessment, shared decision-making process, and where needed the multidisciplinary involvement. These measures support vascular surgeons, patients, and caregivers to achieve genuine shared decision-making, ensuring a meaningful final stage of life for patients.

Background Abdominal aortic aneurysm (AAA) progression lacks proven medications. This study aimed to indirectly compare common drugs’ effects on AAA growth rate using a network meta-analysis (NMA) of randomized controlled trials (RCTs) and cohort studies, assessing the reliability of evidence. Methods We systematically searched the Cochrane Library, Embase, Web of Science, and PubMed until 5 June 2025. A Bayesian NMA synthesized direct and indirect evidence on drug effects on AAA growth rate, using standardized mean differences (SMD) with credible intervals (CrI). Cohort study results were analyzed separately. Results After screening, 11 RCTs (2,135 subjects) and 13 cohort studies were included. Pooled RCT results showed roxithromycin significantly reduced AAA growth (SMD [95% CrI]: 0.39 [-0.69 to −0.10]). Roxithromycin also demonstrated advantages over amlodipine and doxycycline in indirect comparisons. Propranolol, perindopril, metformin, azithromycin, and ticagrelor showed no significant benefits. Cohort studies linked slower growth to statins and glucose-lowering drugs (insulin, metformin). Conclusion Roxithromycin, statins, and metformin show promise for potentially limiting AAA expansion. However, findings are constrained by methodological limitations (study design, sample size), necessitating future validation via high-quality RCTs.

Background General practitioners (GPs) frequently refer patients for abdominal ultrasound. Depending on the clinical context, a ‘triage ultrasound’ can assess multiple potential causes of abdominal symptoms, while a ‘targeted ultrasound’ (point-of-care ultrasound, POCUS) focuses on specific indications (e.g. cholelithiasis). Objective To assess whether medical questions posed by GPs in abdominal ultrasound referral letters are adequate for radiologists to perform their examination, and to identify indications for POCUS by GPs based on exclusion rates and alternative findings in radiological reports. Methods Retrospective study analysing GP referral letters with corresponding radiology reports referred for abdominal ultrasound. Key variables: GP’s medical question, indication type and the radiologist’s final interpretation, following established diagnostic guidelines. Results A total of 1,196 referral letters with corresponding reports were reviewed. Of these, 143 (12%) were excluded, primarily due to missing clinical information from the GP (102; 8.5%). The final sample comprised 1053 referral letters with reports (mean age 59.2 years; 60% female). Sixteen percent of referral letters lacked a medical question, and 33% included exclusively guideline-based indications. The most common guideline-based indications were urolithiasis (43%) and cholelithiasis (39%). For guideline-based requests, radiologists excluded the indicated condition in 75% of cases, and an alternative diagnosis was identified in fewer than 10%. Conclusion GPs frequently provide insufficient clinically relevant information in abdominal ultrasound referral letters. Simple cases with well-defined clinical queries like cholelithiasis, urolithiasis, hydronephrosis and abdominal aortic aneurysm seem suitable for POCUS evaluation, as these are often excluded conditions for which the risk of overlooking serious diagnoses is low.

Aortic aneurysms and dissections are devastating vascular diseases with high mortality, yet no pharmacological therapy has proven effective in halting growth or preventing rupture. Surgical and endovascular repair remain the only treatment options for advanced disease. Animal models have been indispensable in defining mechanisms and testing candidate therapies, but the diversity of protocols, strain-dependent variability, and heterogeneous endpoints complicate interpretation and translation. This review provides an update focused on how to match models to specific research questions. We critically compare commonly used abdominal aortic aneurysm (AAA) models (angiotensin II ± hyperlipidemia, elastase, calcium chloride, β-aminopropionitrile BAPN hybrids, and mineralocorticoid agonist/fludrocortisone models) with thoracic aortopathy and dissection models (BAPN alone or with AngII, genetic models including Marfan and smooth muscle contractile mutations, and AngII + TGF-β blockade). We highlight practical considerations on segment specificity, rupture incidence, lipid dependence, comorbidities, and outcome measurement, with emphasis on rigor and reporting standards. A translational thread on platelet–intraluminal thrombus biology, including the emerging biomarker and therapeutic targets such as glycoprotein VI (GPVI), is integrated across models. We offer a decision grid and rigor checklist to harmonize model use, enhance reproducibility, and accelerate translation.

Vascular smooth muscle cell (VSMC) degeneration is a major mechanism underlying abdominal aortic aneurysm (AAA) formation. However, the upstream signaling pathways that converge on the transcriptional machinery to drive VSMC degeneration remain elusive. Here, we integrated single-nucleus (sn) multi-omics, chromatin immunoprecipitation (ChIP)-seq, and wet lab validation to identify transcriptional effectors of VSMC-MAPK14, which we previously reported to promote AAA. Compared with wild-type (WT) mice, VSMC-Mapk14 knockout (KO) mice displayed reduced VSMC degeneration, as evidenced by decreased expression of markers of endoplasmic reticulum stress, the unfolded protein response, fibrosis, and apoptosis, after 7 days of Ang II infusion. SnRNA-seq revealed increased VSMCs and reduced fibroblast and immune cell populations in KOs. Reclustering VSMCs revealed an increased proportion of contractile cluster and a reduced proportion of fibrotic cluster in KOs. The VSMC differentiation gene program and upstream pathways were upregulated, whereas degeneration pathways, including extracellular matrix remodeling, inflammation, and apoptosis, were downregulated in KO VSMCs. snATAC-seq and validation revealed increased serum response factor (SRF) motif activity and expression but reduced RUNX2 expression in KO VSMCs. Integrative analysis of snATAC-seq, ChIP-seq, and bulk RNA-seq identified the MYOCD/SRF/CArG triad as the driver of the contractile gene program following Mapk14 loss. We further found that the expression of Bcl2, a novel MYOCD/SRF/CArG target, was increased in Mapk14 KO VSMCs. Loss of Mapk14 attenuated MRTFA protein abundance via increased ubiquitin‒proteasome degradation, which was attributed to reduced USP10 protein expression. These findings reveal MAPK14-driven transcriptomic and epigenomic landscapes that promote VSMC degeneration by suppressing SRF/MYOCD/CArG while activating RUNX2 and MRTFA. Our study provides mechanistic insight into MAPK14-mediated VSMC degeneration and provides a basis for MAPK14-targeted therapeutic strategies for AAA.

Pulse wave velocity (PWV) is an indirect measure of vessel stiffness, that has the potential to serve as a meaningful parameter for risk stratification of vascular diseases, such as abdominal aortic aneurysms (AAAs). However, assessing the PWV and pulse wave patterns in the complete abdominal aorta using ultrasound-based pulse wave imaging (PWI) is challenging due to the limited field of view (FOV) and contrast of a single ultrasound (US) probe. Hence, an approach is required that can capture distension of aortas with different levels of stiffness accurately in a large FOV. Therefore, we propose PWI based on dual probe, bistatic US. Single and dual probe ultrasound simulations were performed using finite element models of pressure waves propagating in aortas with different stiffness levels. Next, the approach was tested on an aorta and AAA mimicking phantom in a mock circulation setup. The simulation results show that the FOV, image quality, and PWV-estimation accuracy improve when using the dual probe approach (accuracy range: 94.9 - 99.8 $\%$; R$^{2}$ range: 0.92 - 0.98) compared to conventional US (accuracy range: 12.6 - 93.9 $\%$; R$^{2}$ range: 0.52 - 0.91). The approach was successfully expanded to the phantom study, which demonstrated expected wave patterns within a larger FOV. With dual probe PWI of the non-dilated phantom, the R$^{2}$-value improves (monostatic: 0.95; bistatic: 0.96) compared to use of single probe PWI (0.85). The proposed method shows to be promising for PWV-estimations in less compliant vessels with high wave speeds.

Patient: Male, 74-year-oldFinal Diagnosis: Aorto-spinal fistula with multifocal abscessesSymptoms: Abdominal pain • back painClinical Procedure: —Specialty: General and Internal MedicineObjective: Unknown etiologyBackgroundEndovascular aneurysm repair (EVAR) effectively treats abdominal aortic aneurysms but risks complications, including endoleak and graft infection.Case ReportA 74-year-old man with EVAR, complicated by endoleak the following month with persistent pain following endoleak repair, presented with multiple abscesses (epidural, psoas, and disc space) and an aorto-disc fistula 7 months after the endoleak repair. Long-term corticosteroid use and an interleukin-6 inhibitor for presumed polymyalgia rheumatica contributed to immunosuppression. This misdiagnosis, along with immunosuppression and inconclusive outside imaging, diagnostic tunneling contributed to a delayed diagnosis until discitis, osteomyelitis, and abscesses were discovered on computed tomography (CT). This case is a rare presentation, and there is scant literature on spinal abscess from EVAR. Given the uniqueness and complexity of the presentation, a multidisciplinary approach was required for a better outcome, including multiple surgery teams and multiple medical teams. Management included abscess drainage, EVAR explant with rifampin-soaked Dacron graft reconstruction, surgical debridement, antibiotic beads, and 6 weeks of intravenous daptomycin for coverage of previously positive spinal tissue cultures (methicillin-sensitive Staphylococcus aureus and Cutibacterium acnes) with a plan for lifelong suppression with doxycycline. The patient ultimately had a new endoleak requiring repair, but was doing well as of his last appointment 8 months after his presentation to our facility.ConclusionsThis case demonstrates the need for postoperative vigilance and multidisciplinary care for patients undergoing EVAR. Comprehensive source control and close follow-up have thus far yielded a successful clinical outcome.

Volumetric assessment of abdominal aortic aneurysms (AAA) offers precise pre- and post-endovascular aortic repair (EVAR) evaluation but is laborious. The primary aim was to train and validate a network facilitating automated segmentation and volume determination of pre- and post-EVAR infrarenal AAAs displayed on computed tomography angiographies (CTA). Secondary aim was evaluation of workflow acceleration. Model was trained on ground truth segmentations. Internal and external validation was performed. AI-generated volumes of total aneurysm, lumen, and thrombus were correlated with ground truth. Model-enabled efficiency gains and semi-automatic AAA segmentations performed by three surgeons were measured. For total aneurysm, mean Dice similarity coefficient was 0.972 ± 0.013 and 0.960 ± 0.035 in internal and external validation. AI-generated thrombus volumes showed a very strong correlation with ground truth in internal (r = 0.996) and external validation (r = 0.940). Mean algorithm-facilitated time savings of 117.1 seconds (56.0%) were demonstrated for total aneurysm. Our institution-agnostic network enables automated volumetric analysis of AAAs.

Quality of Life, Cost Effectiveness, and Cost Utility Analysis of Activated Clotting Time Guided Heparinisation vs. a Single Bolus of Heparin in Open Abdominal Aortic Aneurysm Repair.

ObjectiveCompared to stable abdominal aortic aneurysms (AAA), the inflammatory response in perivascular adipose tissue (PVAT) may be exacerbated prior to rupture, leading to functional and structural alterations that manifest as imaging disparities. Radiomics enables the extraction of images features, which can be integrated with machine learning(ML) to construct models for clinical decision support. This study investigated the potential of radiomic features derived from PVAT to predict AAA rupture.MethodsA retrospective analysis was conducted using aortic Computed Tomography Angiography (CTA) images from two centers, comprising patients with either stable or ruptured AAA who had pre-rupture CTA scans. These images were allocated to a development set and an external validation set. After radiomic feature extraction, statistically significant features between the two groups were subjected to dimensionality reduction. Subsequently, ten common ML models were constructed and validated using both internal and external validation sets.ResultsThe development set comprised 37 ruptured patients and 155 non-ruptured patients. The external test set included 6 ruptured patients and 30 non-ruptured patients. A total of 107 radiomic features were extracted per patient, of which 18 exhibited statistically significant differences between groups. After dimensionality reduction, 5 representative features were selected. The constructed models achieved an average accuracy of 0.76 and an average AUC of 0.81 in the internal test set, while the external test set yielded an average accuracy of 0.73 and an average AUC of 0.77.ConclusionSignificant differences exist in PVAT characteristics between ruptured and non-ruptured AAA patients, supporting the feasibility of using radiomic features for rupture prediction with reasonable accuracy.

Physician-modified endografts (PMEGs) are increasingly used for urgent or off-label repair of complex abdominal aortic aneurysms (AAAs) when custom-made devices are unavailable. A key technical step in PMEG preparation is reloading of the modified stent graft into its original delivery system. Aortic valve stent crimpers have recently been repurposed to assist in reloading, but direct comparisons are lacking with the traditional tourniquet technique. This study aims to compare the efficiency and reliability of tourniquet- and crimper-assisted reloading in a controlled benchtop setting. Eighteen reloading procedures were performed using a Medtronic Valiant 38×200 mm thoracic stent graft, with 9 per technique. Trained operators conducted the reloading under standardized conditions. The primary outcome was reloading time. The secondary endpoints included the infolding potential following deployment in simulated aortic models with oversizing conditions of 21%, 34%, and 42%. Postdeployment morphology was assessed by computed tomography (CT) imaging and reviewed by a blinded observer. Continuous data were analyzed using the Mann-Whitney U test and categorical data by Fisher's exact test. The crimper technique significantly reduced the reloading time compared with the tourniquet method (median 3.98 minutes, interquartile range [IQR=3.27-5.23] vs 11.48 minutes [IQR=8.82-17.35]; p=0.001). No infolding was observed in any of the 18 deployed grafts across all oversizing subgroups. Inadvertent proximal clasp release complicated the tourniquet technique (n=3), while this issue was absent with the crimper (n=0, p=0.206). Device integrity was preserved throughout, although the delivery system required replacement once after repeated reuse. This benchtop study demonstrates that the crimper technique provides a faster and more consistent alternative to the traditional tourniquet method for PMEG stent graft reloading. The use of an aortic valve crimper may enhance standardization and workflow efficiency, without infolding.Clinical ImpactIn this bench-top comparison of PMEG reloading techniques, a repurposed aortic valve stent crimper outperformed the traditional tourniquet method by reducing reloading time, without an increase in graft infolding. The improved efficiency associated with the crimper technique highlight its potential value as a standardized approach to PMEG preparation, particularly in time-critical scenarios.

Epigallocatechin gallate (EGCG) partially prevents elastase-induced mechanical and microstructural changes in the mouse ascending aorta in vitro.

Arterial dilation can lead to aneurysm formation, most commonly affecting the aorta and intracranial arteries. Platelets are now recognized as key mediators of vascular inflammation and remodeling, contributing to the initiation and progression of several vascular diseases. While the role of platelets in abdominal aortic aneurysm formation has gained considerable attention and is under active investigation, their contribution to intracranial aneurysm pathophysiology remains poorly understood. In this review, we summarize current mechanistic and preclinical evidence on the development and rupture of intracranial aneurysms. We discuss how platelet interactions with leukocytes, vascular cells, and their procoagulant role may influence inflammatory and tissue damage within the intracranial aneurysm, highlighting gaps in knowledge that could reveal new mechanisms.

Abdominal aortic aneurysm (AAA) is a life-threatening disease. Although AAA is generally asymptomatic, the mortality rate remains very high once rupture occurs, even with successful treatment. The pathophysiology of AAA involves inflammatory cell infiltration, smooth muscle cell apoptosis, and extracellular matrix degradation. However, there are various unclear aspects of pathophysiology due to cellular heterogeneity and multifactorial disease. Moreover, there are no blood biomarkers or available pharmacological drugs for AAA. Extracellular vesicles (EVs) are lipid bilayer particles released from every type of cell for intercellular communication. EVs include proteins, DNA, RNA (mRNA, microRNA), and lipids. EV cargos are delivered to recipient cells and modulate their biological effects. Although fewer studies have investigated EVs in AAA than in other cardiovascular diseases with similar molecular mechanisms, recent research indicates that EVs play a significant role in AAA development. Further research on EVs and AAA will contribute to the elucidation of AAA pathophysiology and the development of novel pharmacological drugs. In this review, we summarize the EV-associated pathophysiology, EV-based biomarkers, and EV-based treatment strategies in AAA. We also discuss the prospects for EVs research in AAA.

Lipoprotein(a) Is Associated With Increased Risk of Abdominal Aortic Aneurysm