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  • Review Article
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Abdominal aortic aneurysm: update on pathogenesis and medical treatments

Nature Reviews Cardiology volume 16, pages 225–242 (2019)Cite this article

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Abstract

Abdominal aortic aneurysm (AAA) rupture is an important cause of death in adults. Currently, the only treatment for AAA is open or endovascular surgical repair. In most parts of the developed world, AAAs can be identified at an early stage as a result of incidental imaging and screening programmes. Randomized clinical trials have demonstrated that early elective surgical repair of these small AAAs is not beneficial, and an unmet clinical need exists to develop medical therapies for small AAAs that limit or prevent the progressive expansion and rupture of the aneurysm. A large amount of research is currently being performed to increase the understanding of AAA pathogenesis and ultimately lead to the development of medical therapies, such as drug-based and cell-based strategies for this disease. This Review summarizes the latest research findings and current theories on AAA pathogenesis, including discussion of the pros and cons of current rodent models of AAA, and highlights potential medical therapies for AAA, summarizing previous, ongoing and potential clinical trials of medical interventions for small AAAs. This expanding volume of research on AAA is expected to result in a range of novel medical therapies for AAA within the next decade.

Key points

  • Currently, no drug therapy is available for abdominal aortic aneurysm (AAA), which drives a substantial interest in the pathogenesis of this condition.

  • Most previous studies in animals and humans indicate a major role of chronic aortic inflammation in AAA pathogenesis.

  • Evidence suggests that inherited and haemodynamic factors also have an important role in AAA pathogenesis.

  • Atherosclerosis might be important in the development of some AAAs.

  • Clinical trials of drug therapies for AAA have all had negative results; reports of ongoing trials are expected over the next 2 years.

  • Alternative design methods for future clinical trials on AAA drugs should be considered.

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Fig. 1: Potential effects of inflammation in AAA pathogenesis.
Fig. 2: Potential role of excessive positive remodelling in AAA pathogenesis.
Fig. 3: Examples of different AAA phenotypes.
Fig. 4: Schematic overview of the TGFβ pathway.

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Acknowledgements

I thank Evan Mathews (James Cook University, Australia) for help with preparing figure 3 before submission; Anne-Marie Hill and Alexandra Golledge (James Cook University, Australia) for help with the references, other figures and proof reading; and the researchers from the Queensland Research Centre for Peripheral Vascular Disease, especially Joseph Moxon, Corey Moran, Dylan Morris and Smriti Krishna, for their ongoing research on AAA pathogenesis, which has contributed towards the insight included in this Review. Finally, I apologise to scientists whose research could not be included in this Review due to space limitations. The author’s research was supported by grants from the National Health and Medical Research Council (1098717, 1079369 and 1022752), Townsville Hospital and Health Service Study, Education and Research Trust Fund and Queensland Government. J.G. holds a Practitioner Fellowship from the National Health and Medical Research Council (1117601) and a Senior Clinical Research Fellowship from the Queensland Government.

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Nature Reviews Cardiology thanks G.-P. Shi and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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  1. Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia

    Jonathan Golledge

  2. Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia

    Jonathan Golledge

  3. Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia

    Jonathan Golledge

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J.G. is employed by a public hospital (The Townsville Hospital, Australia) and university (James Cook University, Australia) as a professor of vascular surgery.

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Golledge, J. Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nat Rev Cardiol 16, 225–242 (2019). https://doi.org/10.1038/s41569-018-0114-9

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