Atherosclerotic Aneurysm Research Articles

Outcomes after Open Surgery for Inflammatory Abdominal Aortic Aneurysm: A 10-Year Single-Center Experience

Inflammatory abdominal aortic aneurysms (IAAAs) are rare clinical entitieswith an exaggerated inflammatory component. The aim of this study is to report outcomes of a single-center 10-year experience in open surgical management of IAAA and to compare the results with noninflammatory, atherosclerotic abdominal aortic aneurysms (non-IAAAs). We retrospectively reviewed the medical records of 18 patients with IAAA selected out of patients with AAA who underwent open surgery in the Department of Vascular and Endovascular Surgery at the University Hospital Dusseldorf from January 2006 to December 2015. These patients were matched with controls, selected from a prospectively retained database of patients with AAA undergoing open surgery during the study period. A 1:2 case-control match regarding age, gender, and year of treatment was performed. We analyzed both groups for preoperative parameters, intraoperative findings, and early postoperative outcomes. The 2 groups showed considerable similarities with no significant differences in the clinical features. Both groups outlined comparable aneurysm size (62 vs. 56mm); however, the mean preoperative C-reactive protein was found to be significantly elevated in the study group (mean value: 2.6 vs. 0.9mg/dL, P<0.05). Most patients were operated using a standard transperitoneal median laparotomy approach; only 1 patient of each group was operated using a left retroperitoneal approach. There was no significant difference in operation time (190 vs. 194 min) and 30-day mortality 0%. The in-hospital mortality was 11% in the study group and 0% in the control group. We found a significant higher complication rate in the study group 10 (56%) vs. 12 (33%). The major complications were also more frequent in the study group 4 (22%) vs. 6 (16.7%). IAAA showed a statistically significant longer length of intensive care unit and hospital stay when compared with non-IAAA (7 and 20days vs. 2 and 14days, P<0.05). IAAAs outlined a significantly greater transfusion requirement for erythrocytes and fresh frozen plasma than non-IAAA. Open surgical treatment of IAAA guarantees a regression of the inflammatory process in most patients, which was detected through ultrasound in follow-up examination, although the approach to the surgical site is highly demanding. IAAA exhibits clear gender predominance and is associated with significantly higher transfusion requirement, early morbidity, and length of stay.

The crosstalk between vascular MSCs and inflammatory mediators determines the pro-calcific remodelling of human atherosclerotic aneurysm

BackgroundHuman mesenchymal stem cells (MSCs) possess well-known reparative abilities, but any defect of the immunomodulatory activity and/or the differentiation process may determine the development of human diseases, including those affecting the vascular wall. MSCs residing within the human aortic wall represent a potential cell mediator of atherosclerotic aneurysm development.MethodsMSCs isolated from healthy and aneurysm aortas were characterized by flow cytometer and tested for differentiation properties. Healthy aorta (ha)-MSCs were then subjected to inflammatory stimuli to evaluate the microenvironmental impact on their function and involvement in vascular remodelling.ResultsAbdominal aortic aneurysm (AAA)-MSCs were isolated from calcified and inflamed aortas of 12 patients with high serum levels of MMP-9 protein. AAA-MSCs expressed typical mesenchymal markers and, in line with the histological analysis, elevated levels of OPN, an osteogenic marker also involved in vascular remodelling. AAA-MSCs were highly osteogenic and underwent intense calcium deposition under proper stimulation; moreover, AAA-MSCs were able to differentiate into tubule-like structures in Matrigel, even if the lack of CD146 and the reduced structural stability suggested an inefficient maturation process. We further demonstrated an association between osteogenesis and inflammation; indeed, ha-MSCs cultured with either cytokines (TNF-α, IL-1β) or AAA-PBMCs showed increased expression of MMP-9 and osteogenic markers, to the detriment of the adipogenic regulator PPAR-γ. Interestingly, the culture with inflammatory cells highly stimulated ha-MSCs towards the osteogenic commitment.ConclusionsAAA-MSCs displayed high osteogenic potential and pathological angiogenesis that represent crucial steps for AAA progression; we showed that the inflammatory process critically addresses human vascular MSCs towards a pathological behaviour, inducing vascular bone matrix deposition and remodelling. Inhibition of this pathway may represent a pharmacological approach against arterial calcification.

Midterm results of internal iliac artery aneurysm embolization.

We describe the immediate and midterm results of endovascular treatment of isolated internal iliac artery aneurysms (IIAA). This was a retrospective single center study. From 2005 to 2014, data from 20 consecutive patients who had an embolisation for an isolated atherosclerotic internal iliac artery aneurysm underwent an endovascular treatment. We retrospectively evaluated the technical aspects and outcomes. The mean aneurysm diameter was 42mm (range 30-97mm). No perioperative deaths or treatment failures occurred. No endoleaks or secondary aneurysm ruptures were observed during the follow-up. Three patients experienced disabling buttock claudication, which was spontaneously remissive in two cases. No relationship was found between buttock claudication and the patency of the contralateral internal iliac artery and the deep femoral artery. Six patients (30%) died during follow-up. Among these, three patients died due to cardiovascular events. The mean follow-up interval was 24 months (range 6-96 months). The endovascular treatment of isolated internal iliac artery aneurysm is safe in the short-term and could prevent secondary aneurysm rupture at midterm.

Comparison of blood rheological models in patient specific cardiovascular system simulations

Newtonian, Quemada and Casson blood viscosity models are implemented in order to simulate the rheological behavior of blood under pulsating flow conditions in a patient specific iliac bifurcation. The influence of the applied blood constitutive equations is monitored via the wall shear stress (WSS) distribution, magnitude and oscillations, non-Newtonian importance factors, and viscosity values according to the shear rate. The distribution of WSS on the vascular wall follows a pattern which is independent of the rheological model chosen. On the other hand, the WSS magnitude and oscillations are directly related to the blood constitutive equations applied and the shear rate. It is concluded that the Newtonian approximation is satisfactory only in high shear and flow rates. Moreover, the Newtonian model seems to overestimate the possibility for the formation of atherosclerotic lesions or aneurysms at sites of the vascular wall where the WSS are oscillating.

Insights from molecular modeling into the selective inhibition of cathepsin S by its inhibitor.

Cathepsin S has been demonstrated to play a crucial role in the remodeling of extracellular matrix proteins such as elastin and collagen, which in turn contribute to the structural integrity of the cardiovascular wall. Atherosclerotic lesions, aneurysm formation, plaque rupture, thrombosis, and calcification are some of the cardiovascular disorders related to cathepsin S. A highly selective inhibitor of human as well as animal cathepsin S, RO5444101, was recently reported to attenuate the progression of atherosclerotic lesions. Here, we attempted to gain insight into the molecular mechanism of action of RO5444101 on cathepsin S by performing molecular docking and molecular dynamics (MD) simulation studies. The results of our studies correlate well with relevant reported experimental data and potentially explain the selectivity of this inhibitor for cathepsin S rather than cathepsin L1/L, cathepsin L2/V, and cathepsin K, which share conserved catalytic sites and have sequence similarities of 49%, 50%, and 55%, respectively, with respect to cathepsin S. In contrast to those closely related cathepsins, 20 ns MD simulation data reveal that the overall interaction of cathepsin S with RO5444101 is more stable and involves more protein-molecule interactions than the interactions of the inhibitor with the other cathepsins. This study therefore considerably improves our understanding of the molecular mechanism responsible for cathepsin S inhibition and facilitates the identification of potential novel selective inhibitors of cathepsin S.

MicroRNA-181b Controls Atherosclerosis and Aneurysms Through Regulation of TIMP-3 and Elastin.

Atherosclerosis and aneurysms are leading causes of mortality worldwide. MicroRNAs (miRs) are key determinants of gene and protein expression, and atypical miR expression has been associated with many cardiovascular diseases; although their contributory role to atherosclerotic plaque and abdominal aortic aneurysm stability are poorly understood. To investigate whether miR-181b regulates tissue inhibitor of metalloproteinase-3 expression and affects atherosclerosis and aneurysms. Here, we demonstrate that miR-181b was overexpressed in symptomatic human atherosclerotic plaques and abdominal aortic aneurysms and correlated with decreased expression of predicted miR-181b targets, tissue inhibitor of metalloproteinase-3, and elastin. Using the well-characterized mouse atherosclerosis models of Apoe-/- and Ldlr-/-, we observed that in vivo administration of locked nucleic acid anti-miR-181b retarded both the development and the progression of atherosclerotic plaques. Systemic delivery of anti-miR-181b in angiotensin II-infused Apoe-/- and Ldlr-/- mice attenuated aneurysm formation and progression within the ascending, thoracic, and abdominal aorta. Moreover, miR-181b inhibition greatly increased elastin and collagen expression, promoting a fibrotic response and subsequent stabilization of existing plaques and aneurysms. We determined that miR-181b negatively regulates macrophage tissue inhibitor of metalloproteinase-3 expression and vascular smooth muscle cell elastin production, both important factors in maintaining atherosclerotic plaque and aneurysm stability. Validation studies in Timp3-/- mice confirmed that the beneficial effects afforded by miR-181b inhibition are largely tissue inhibitor of metalloproteinase-3 dependent, while also revealing an additional protective effect through elevating elastin synthesis. Our findings suggest that the management of miR-181b and its target genes provides therapeutic potential for limiting the progression of atherosclerosis and aneurysms and protecting them from rupture.

Unusual and Unexpected Complications of Atherosclerotic Coronary Artery Aneurysms

A series of four patients with coronary aneurysms who were thought to have benign coronary ectasia in last decade but had acute coronary syndrome in last two years are presented First patient had triple vessel coronary ectasia and myocardial infarction (MI) 10 years back and had bare metal stent to aneurysmal left circumflex artery. He represented with inferior MI. Repeat angiogram showed triple vessel disease with thrombotic sub-total occlusion of aneurysmal right coronary artery (RCA) and was managed by urgent coronary artery bypass surgery(CABG). Second patient presented with inferior MI on multiple occasions requiring percutaneous interventions (PCI) with thrombosuction. On third occasion, he had PCI and bare metal stent to distal RCA. Subsequently he is doing well on oral anticoagulation and aspirin. Third subject had PCI to RCA, a decade earlier following inferior MI with concurrent aneurysm of circumflex artery. He represented with large NSTEMI with ongoing chest pain. Repeat angiogram showed thrombotic occlusion of aneurysmal segment and was managed with covered stent to aneurysmal segment with good result. The last patient presented with inferior MI and had drug eluting stent to proximal aneurysmal RCA. He represented with inferior MI. Repeat angiogram and OCT both showed large protruding thrombus into the stented aneurysmal segment and was excluded by covered stent along with anticoagulation and aspirin. In summary, coronary aneurysms are rare compared to stenotic CAD. Once thought to be benign are more sinister. Judicious use of PCI, CABG and combination of anticoagulation and antiplatelet are currently the mainstay of therapy.

Vascular diseases: aortitis, aortic aneurysms, and vascular calcification.

Inflammatory diseases of the aorta broadly include noninfectious and infectious aortitis, periaortitis, atherosclerosis, and inflammatory atherosclerotic aneurysms. Aortitis is uncommon but is increasingly recognized as an important cause of aortic aneurysms and dissections. Abdominal (AAA) and thoracic aortic aneurysms (TAA) have different pathologies and etiologies. AAAs are the most common type of aortic aneurysm, and the vast majority of these are atherosclerotic. The causes of TAA vary depending on the site of involvement, but medial degeneration is a common pathologic substrate, regardless of etiology, and genetic influences play a prominent role in TAA expression. Standardized classification schemes for inflammatory and degenerative diseases of the aorta have only recently been added to the pathology literature. A brief overview of the new histopathologic classifications for aortic inflammatory and degenerative diseases has recently been published by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology as a consensus document on the surgical pathology of the aorta. Vascular calcification is a highly regulated biologic process, and the mechanisms leading to vascular calcification are under investigation. Calcification may occur in the intima (atherosclerotic) or in the media secondary to metabolic disease. Rarely, vascular calcification may be associated with genetic disorders.

Octopus around heart: A Case Report

Left main coronary aneurysm is extremely rare entity under umbrella of atherosclerotic coronary artery disease. Epidemiological and clinical data are lacking to guide management strategy. The case described here is of 72 years old male who presented with SIHD (stable ischemic heart disease). Coronary angiography revealed coronary artery aneurysm involving left main. Out of less than 50 cases reported worldwide, most cases deal with non-atherosclerotic causes of left main coronary artery aneurysm. This case report of atherosclerotic left main coronary artery aneurysm becomes unique as the eldest patient with such disease to be documented. The standard treatment strategy of CABG for such aneurysm whether appropriate for such clinical presentation in geriatric patients is not known.

Abstract 19: Role of Adenosine-to-Inosine RNA Editing of Alu Elements in Human Vascular Inflammatory Diseases

Background: Adenosine to inosine (A-to-I) RNA editing is catalysed by ADARs (adenosine deaminases acting on RNA) and is an important posttranscriptional regulator of RNA metabolism. Although RNA editing is essential for life, its role in cardiovascular disease is unknown. Methods and Results: RNA-sequencing (RNA-seq) of human endothelial cells revealed that ADAR1 is the main RNA editor in HUVECs. The vast majority of editing events are detected in Alu regions due to their ability to form double-stranded structures, a prerequisite for RNA editing. A-to-I RNA editing of the primate-specific Alu elements is observed in 25% of poly(A)+ transcripts and in 44% of ribosomal RNA-depleted transcripts. Cathepsin S (CTSS), an extracellular matrix degrading enzyme, has 3 Alu elements in its 3’-untranslated region and is among the most extensively edited mRNAs. Interestingly, ADAR1 silencing downregulates CTSS mRNA expression, whereas ADAR1 overexpression results in an increase of both CTSS RNA editing rate and CTSS mRNA expression. Mechanistically, RNA immunoprecipitation (RIP), luciferase reporter and iCLIP assays showed that A-to-I RNA editing of the Alu elements in the 3’UTR of CTSS mRNA regulates the recruitment of the stabilizing RNA-binding protein HuR to CTSS 3’UTR and, thus, controls CTSS mRNA stability and expression. CTSS Alu RNA editing is increased under hypoxic or pro-inflammatory conditions in vitro , as well as in patients with coronary or carotid atherosclerotic vascular disease. Further, the extent of CTSS Alu RNA editing rate correlated with various markers of subclinical atherosclerosis including intima-media thickness and number of atherosclerotic plaques. Importantly, ADAR1 and the extent of CTSS RNA editing correlated with CTSS expression levels in patients’ samples from 6 non-overlapping cohorts of patients with inflammatory vascular diseases (total n=366), including peripheral blood mononuclear cells, carotid atherosclerotic plaques and thoracic aortic aneurysms. Conclusion: This study shows for the first time that Alu A-to-I RNA editing is a critical modulator of inflammatory gene expression in all stages of atherosclerotic vascular disease development.

Results after elective open repair of pararenal abdominal aortic aneurysms

This study presents a retrospective analysis of long-term outcomes and factors influencing early and late results of a 20-year experience with open repair of atherosclerotic pararenal abdominal aortic aneurysms (PAAAs). Records of consecutive patients who underwent open repair of PAAA between 1990 and 2010 at a tertiary referral care center were analyzed for demographics, comorbidities, operative variables, complications, and 30-day mortality. Long-term results were also assessed through a local electronic medical database and direct follow-up. Variables influencing early and late results were evaluated by univariate and multivariate logistic regression analyses, stepwise backward elimination, and Cox proportional hazard regression. The study included 200 patients (94% men; mean age, 69.5years) who were monitored for a mean of 107.3months. The aneurysm was juxtarenal in 78% of patients, suprarenal in 19.5%, and type IV thoracoabdominal in 2.5%. Mortality at 30days was 2.5%. At least one major complication occurred in 51.5%. Postoperative acute renal failure (pARF) occurred in 11% of the patients, 3% had temporary hemodialysis, but only 0.5% required chronic hemodialysis. pARF was significantly related to preoperative renal function (P= .009), visceral ischemia >30minutes (P= .05), and supraceliac or supramesenteric clamp site (P= .005). Respiratory complications (13.8%) were associated with an increasing stage of chronic obstructive pulmonary disease (P= .020), proximal clamp site (P= .047), and intraoperatively infused crystalloids (P= .014). Cardiac complications (12.8%) were related to previous myocardial infarction (P= .031) and proximal clamp site (P= .003). Late deaths were observed in 21.5%. Mean survival was 50months, with Kaplan-Meier survival estimates of 78% at 5years and 60.5% at 10years. Variables influencing long-term survival included age (hazard ratio [HR], 2.67; P= .01), chronic obstructive pulmonary disease stage 2 (HR, 5.14; P= .01) and stage 3 (HR, 4.54; P= .03), postoperative cardiac complication (HR, 3.93; P ≤ .00), previous myocardial infarction (HR, 1.47; P= .02), peripheral artery disease (HR, 1.97; P= .03), and smoking (HR, 1.17; P= .02). Survival and late-onset renal insufficiency were unaffected by preoperative renal function. Late renal failure was observed in 6.2% of the patients but did not predict mortality. Conventional surgical repair of PAAAs can be performed with acceptable short-term and long-term mortality. Although pARF is frequent, chronic hemodialysis at discharge is rare. Cardiac and respiratory complications are also common and associated with worse survival. Our data represent a potentially useful benchmark for complex endovascular repairs of this type of aneurysm.

Medical image of the week: atherosclerotic aneurysm of aortic arch and decsecnding thoracic aorta

Medical image of the week: atherosclerotic aneurysm of aortic arch and decsecnding thoracic aorta

Medical image of the week: atherosclerotic aneurysm of aortic arch and descecnding thoracic aorta

Medical image of the week: atherosclerotic aneurysm of aortic arch and descecnding thoracic aorta

Large-Sized Bilateral Atherosclerotic Axillary Artery Aneurysms: A Case Report.

Axillary artery aneurysms are most commonly caused by trauma, while atraumatic cases are very rare. Atherosclerosis, collagen tissue diseases, and mycotic infections are additional etiological factors for this type of aneurysms. Once developed, an aneurysm poses risk for hand ischemia or neurologic complications due to embolic events and neural compression. Due to this, diagnosis and treatment of an aneurysm are crucial. We report a case of giant bilateral axillary artery aneurysms developed as a consequence of atherosclerosis.

Outcomes of Atherosclerotic Cerebral Aneurysm Surgery in Advanced Age Patients

Background: The advanced age of patients usually increases the incidence of atherosclerotic cerebral aneurysm. The risk of treating this type of aneurysm by surgical clipping is development of a thromboembolic event. We would like to know the exact rate of ischemic event and the risk factors associated with embolic stroke by treatment of this aneurysm in elderly patients. Methods: This is a retrospective cohort study in patients older than 70 years who were diagnosed as unruptured atherosclerotic cerebral aneurysm and underwent microsurgical clipping between January 2012 and August 2014. We compared the ischemic events and factors associated with embolic stroke with a younger group of patients (70 years old). The endpoint was the incidence of cerebral infarction evaluated by brain imaging and discharge modified Rankin Scale (mRS) score. A statistical analysis of the factors associated with embolic stroke was done by Fisher’s exact tests in each group. Results: Among 30 atherosclerotic cerebral aneurysms of older group of patient, only 2 patients (6.7%) were associated with postoperative cerebral infarction. There were no factors associated with ischemic outcome. In the younger age group, only 1 patient (1.4%) developed cerebral infarction and the number of clips was associated with ischemic outcome (P = 0.01). Conclusions: The older patients had an increasing trend of cerebral infarction after surgery compared with the younger patients. No independent risk factors were associated with cerebral infarction after atherosclerotic cerebral aneurysm surgery in the greater than 70-year-old group.

Aorto-duodenal fistula: a rare but serious complication of gastrointestinal hemorrhage. A case report.

A primary aortoduodenal fistula (PADF) is a rare cause of gastrointestinal bleeding that is difficult to diagnose (and sometimes not diagnosed until a laparotomy.) A PADF is associated with high mortality if undiagnosed and untreated (the mortality rate of nearly 100% in the absence of a surgical intervention). While this condition is extremely rare with an incidence rate at autopsy of 0.04% to 0.07%, a secondary ADF occurs much more commonly (the post-operative incidence of 0.5% to 2.3%) and is due to prior aortic surgery and/or the placement of a synthetic aortic graft. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm or without it when no identifiable source of bleeding is found. We present an autopsy case of a 59-year-old man with no history of an abdominal aortic aneurysm who presented with intermittent massive gastrointestinal bleeding. The autopsy revealed a pinhole fistula. It was identified between an atherosclerotic abdominal aortic aneurysm and the lower horizontal part of the duodenum. Our case indicates that the aortoenteric fistula can result in fatal gastrointestinal bleeding. This case is unique in that the fistula formed as a result of a complex atherosclerotic abdominal aorta and a localized necrotizing granulomatous aortitis the etiology of which was not clear.

Long-Term Outcomes of Open Repair of Inflammatory and Atherosclerotic Abdominal Aortic Aneurysms

Background: Abdominal aortic aneurysms (AAA) are a common vascular disease mostly affecting those over the age of 65 years. Open surgical repair (OSR) is considered the gold standard for the treatment of AAA, however longterm mortality and morbidity still remain high in patients with inflammatory AAA, when compared to atherosclerotic AAA. The aim of this study was to evaluate long-term outcomes of both inflammatory and atherosclerotic AAA after OSR. Methods: Out of 837 aortic interventions, 149 patients were identified as having undergone open surgical repair for AAA between 2003 and 2013. Of the 149 patients, histopathological data was available for 92 patients with open AAA repair. Kaplan-Meier curves were analysed to evaluate probability of survival. Results: Patients with inflammatory AAA were younger (70 years) by an average of 2 years compared to atherosclerotic AAA (72 years). Morbidity and length of intensive care stay were insignificantly different in both groups. Inflammatory AAA were associated with higher all cause survival rate (82%) compared to atherosclerotic AAA (68%) (P=0.008) after ten years. Conclusion: There was no difference in clinical outcomes between both atherosclerotic AAA and inflammatory AAA, which is due to the technique used. IAAA were associated with lower mortality rates and improved all cause survival at ten years post open surgical repair.

Surgical treatment of a spontaneous rupture of a giant common carotid artery aneurysm

Primary atherosclerotic aneurysms of the carotid artery are extremely are. Most cases are due to atherosclerotic disease, pseudoaneurysms secondary to neck trauma or previous surgery and mycotic aneurysms. Vascular surgeons will very likely encounter only 2 or 3 of these aneurysms in their professional life as surgeons. Although rare, these aneurysms pose a significant risk to the patient, due to embolisation of the thrombus, neurological complications, compression of adjacent neck structures and, more rarely, rupture from infection and previous surgery. The following case report describes the presentation and surgical treatment of a spontaneously ruptured gigantic common carotid artery aneurysm. DOI: http://dx.doi.org/10.21615/cesmedicina.30.1.8

Diabetes may affect intracranial aneurysm stabilization in older patients: Analysis based on intraoperative findings.

Background:Only a small proportion of aneurysms progress to rupture. Previous studies have focused on predicting the rupture risk of intracranial aneurysms. Atherosclerotic aneurysm wall appears resistant to rupture. The purpose of this study was to evaluate clinical and morphological factors affecting atherosclerosis of an aneurysm and identify the parameters that predict aneurysm stabilization.Methods:We conducted a retrospective analysis of 253 consecutive patients with 291 unruptured aneurysms who underwent clipping surgery in a single institution between January 2012 and October 2013. Aneurysms were categorized based on intraoperative video findings and assessed morphologic and demographic data. Aneurysms which had the atherosclerotic wall without any super thin and transparent portion were defined as stabilized group and the others as a not-stabilized group.Results:Of the 207 aneurysms, 176 (85.0%) were assigned to the not-stabilized group and 31 (15.0%) to the stabilized group. The relative proportion of stabilized aneurysms increased significantly as the age increased (P < 0.001). Univariate logistic analysis showed that age ≥65 years (P < 0.001), hypertension (P = 0.012), diabetes (P = 0.007), and height ≥3 mm (P = 0.007) were correlated with stabilized aneurysms. Multivariate logistic analysis showed that age ≥65 years (P = 0.009) and hypertension (P = 0.041) were strongly correlated with stable aneurysms. In older patients (≥65 years of age), multivariate logistic regression revealed that only diabetes was associated with stabilized aneurysms (P = 0.027).Conclusions:In patients ≥65 years of age, diabetes mellitus may highly predict the stabilized aneurysms. These results provide useful information in determining treatment and follow-up strategies, especially in older patients.

A Five-Year Experience of Sparing Treatment of Descending Aortic Atherosclerotic Aneurysms

A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development of conservative treatments and elaboration of indications for surgery. A total of 97 patients with thoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have been examined over a 5-year period. They received multifaceted anti-inflammatory medical treatment to strengthen the aortic wall and control its possible expansion. Operative treatment was offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting mortality is the presence of co-morbidities requiring permanent medical corrective treatment irrespective of surgical or medical treatment provided. It is also important to outline the indications for surgery based on multifactorial pathogenetic manifestations. Treatment aiming at the reversal of ethiopathogenic mechanisms of disease progression contributes to a significant longer survival in DAA patients.