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  • Review Article
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Diagnostic and therapeutic strategies for small abdominal aortic aneurysms

Nature Reviews Cardiology volume 8, pages 338–347 (2011)Cite this article

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Abstract

Abdominal aortic aneurysms (AAA) affect 5% of the population in developed countries and are characterized by progressive aortic dilatation with an unpredictable time course. This condition is more common in men than in women, and in smokers than in nonsmokers. If left untreated, AAA can result in aortic rupture and death. Pathologically, aortic extracellular matrix degradation, inflammation, and neovascularization are hallmarks of AAA. Diagnosis of AAA and subsequent surveillance utilize established aortic imaging methods, such as ultrasound, CT, and MRI. More-speculative diagnostic approaches include molecular and cellular imaging methods that interrogate the underlying pathological processes at work within the aneurysm. In this Review, we explore the current diagnostic and therapeutic strategies for the management of AAA. We also describe the diagnostic potential of new imaging techniques and therapeutic potential of new treatments for the management of small AAA.

Key Points

  • Abdominal aortic aneurysms (AAA) are a common and potentially lethal dilatation of the aorta

  • AAA can progress and eventually rupture if left untreated, leading to a high risk of mortality

  • The diameter of the aneurysm is currently the best predictor of rupture

  • Imaging has a major role in both secondary prevention of AAA and in planning the treatment of patients with this condition

  • Pharmacological therapies considerably extend the time from detection of AAA to consideration of repair

  • Mechanical intervention, through open surgery or endovascular repair, is the only treatment that has been shown to be effective in preventing AAA rupture

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Figure 1: Photomicrograph of a two-dimensional color-coded echo-Doppler ultrasound scan showing aortic dissection with the formation of an adventitial hematoma.
Figure 2: CT image of an abdominal aortic aneurysm (AAA) with eccentric mural thrombus.
Figure 3: Spontaneous ex vivo MRI image showing signal-loss from endogeneous hemosiderin in an excised human abdominal aortic aneurysm specimen.
Figure 4: Coronal sections of an abdominal aortic aneurysm.
Figure 5: Monitoring and treatment of abdominal aortic aneurysm.

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Authors and Affiliations

  1. Translational and Molecular Imaging Institute, Mount Sinai School of Medicine, 1428 Madison Avenue, Atran Building 8th Floor, New York, NY 10029, USA

    Ahmed Klink, Willem J. M. Mulder & Zahi A. Fayad

  2. INSERM U698, CHU X. Bichat, Secteur C. Bernard, 46 rue Henri Huchard, 75877 Paris, France

    Fabien Hyafil, Olivier Meilhac, Jean-Baptiste Michel & Didier Letourneur

  3. School of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge CB2 0SP, UK

    James Rudd

  4. Department of Surgery, Division of Vascular Surgery, Mount Sinai School of Medicine, 5 East 98th Street, New York, NY 10029, USA

    Peter Faries & Irene C. Turnbull

  5. Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA

    Valentin Fuster

  6. Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0SP, UK

    Ziad Mallat

  7. Department of Pharmacology and system therapeutics, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA

    Francesco Ramirez

  8. Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, F.A.F.C. Wentgebouw, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands

    Gert Storm

  9. Department of Cell Biology and Physiology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA

    Robert Thompson

  10. Division of Nephrology and Hypertension, Department of Medicine, Autónoma University, Avda Reyes Catolicos 2, 28040 Madrid, Spain

    Jesus Egido

  11. Vascular Research Laboratory, Fundación Jiménez Díaz, Autónoma University, Avda Reyes Católicos 2, 28040 Madrid, Spain

    Jose L. Martín-Ventura

  12. Department of Atherothrombosis and Cardiovascular Imaging, Centro Nacional de Investigaciones Cardiovasculares, Melchor Fernández Almagro 3, 28029 Madrid, Spain

    Carlos Zaragoza

Authors
  1. Fabien Hyafil
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  2. James Rudd
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  3. Peter Faries
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  8. Jean-Baptiste Michel
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  14. Jose L. Martín-Ventura
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  15. Carlos Zaragoza
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  16. Didier Letourneur
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  17. Zahi A. Fayad
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Contributions

Data for the article were researched by A. Klink. F. Hyafil, J. Rudd, Z. Mallat, O. Meilhac, J.-B. Michel, G. Storm, J. Egido, J. L. Martín-Ventura, C. Zaragoza and D. Letourneur. All authors contributed to the discussion of content. The article was written by A. Klink. F. Hyafil, J. Rudd, Z. Mallat, O. Meilhac, J.-B. Michel, G. Storm, J. Egido, J. L. Martín-Ventura, C. Zaragoza and D. Letourneur. All authors reviewed/edited the manuscript before submission and after peer-review.

Corresponding author

Correspondence to Zahi A. Fayad.

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The authors declare no competing financial interests.

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Klink, A., Hyafil, F., Rudd, J. et al. Diagnostic and therapeutic strategies for small abdominal aortic aneurysms. Nat Rev Cardiol 8, 338–347 (2011). https://doi.org/10.1038/nrcardio.2011.1

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