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  • Review Article
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Pathophysiology and epidemiology of abdominal aortic aneurysms

Nature Reviews Cardiology volume 8, pages 92–102 (2011)Cite this article

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Abstract

Abdominal aortic aneurysms (AAAs) are found in up to 8% of men aged >65 years, yet usually remain asymptomatic until they rupture. Rupture of an AAA and its associated catastrophic physiological insult carries overall mortality in excess of 80%, and 2% of all deaths are AAA-related. Pathologically, AAAs are associated with inflammation, smooth muscle cell apoptosis, and matrix degradation. Once thought to be a consequence of advanced atherosclerosis, accruing evidence indicates that AAAs are a focal representation of a systemic disease of the vasculature. Risk factors for AAAs include increasing age, male sex, smoking, and low HDL-cholesterol levels. Familial associations exist and although susceptibility genes have been described on the basis of candidate-gene studies, robust genetic studies have failed to discover causative gene mutations. The surgical management of AAAs has been revolutionized by minimally invasive endovascular repair. Ongoing randomized trials will establish whether endovascular repair confers a survival advantage over open surgery for patients with a ruptured AAA. In many countries, centralization of vascular surgical services has largely been driven by the improved outcomes of elective aneurysm surgery in specialized centers, the widespread adoption of endovascular techniques, and the introduction of screening programs.

Key Points

  • Abdominal aortic aneurysms are a local representation of a systemic disease process

  • Ruptured abdominal aortic aneurysms continue to be associated with high mortality

  • Screening programs target men aged >65 years, as this group is at highest risk of developing an abdominal aortic aneurysm

  • The diameter of an abdominal aortic aneurysm is currently the only validated measure of rupture risk

  • Endovascular repair has substantially reduced perioperative morbidity and mortality of abdominal aortic aneurysms

  • Centralization of vascular surgical services has led to improved outcomes among patients with an abdominal aortic aneurysm

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Figure 1: Three-dimensional reconstruction of a CT angiogram showing a large abdominal aortic aneurysm and associated right common iliac artery aneurysm.
Figure 2: Distribution of screened individuals by age group and AAA size.
Figure 3: Estimates for total survival and aneurysm-related survival during 8 years of follow-up.

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Authors and Affiliations

  1. St. George's Vascular Institute, St. James' Wing, St. George's Hospital, Blackshaw Road, SW17 0QT, London, UK

    Ian M. Nordon, Robert J. Hinchliffe, Ian M. Loftus & Matt M. Thompson

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  2. Robert J. Hinchliffe
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All the authors contributed to discussion of content for the article. I. M. Nordon researched data to include in the manuscript, wrote the manuscript, and revised the manuscript in response to the peer-reviewers' comments. R. J. Hinchliffe and I. M. Loftus wrote the manuscript and reviewed and edited the manuscript before submission. M. M. Thompson reviewed and edited the manuscript before submission.

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Correspondence to Matt M. Thompson.

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M. M. Thompson is a consultant for Cook Medical and Medtronic. The other authors declare no competing interests.

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Nordon, I., Hinchliffe, R., Loftus, I. et al. Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol 8, 92–102 (2011). https://doi.org/10.1038/nrcardio.2010.180

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