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Abdominal aortic aneurysms

Nature Reviews Disease Primers volume 4, Article number: 34 (2018) Cite this article

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Abstract

An abdominal aortic aneurysm (AAA) is a localized dilatation of the infrarenal aorta. AAA is a multifactorial disease, and genetic and environmental factors play a part; smoking, male sex and a positive family history are the most important risk factors, and AAA is most common in men >65 years of age. AAA results from changes in the aortic wall structure, including thinning of the media and adventitia due to the loss of vascular smooth muscle cells and degradation of the extracellular matrix. If the mechanical stress of the blood pressure acting on the wall exceeds the wall strength, the AAA ruptures, causing life-threatening intra-abdominal haemorrhage — the mortality for patients with ruptured AAA is 65–85%. Although AAAs of any size can rupture, the risk of rupture increases with diameter. Intact AAAs are typically asymptomatic, and in settings where screening programmes with ultrasonography are not implemented, most cases are diagnosed incidentally. Modern functional imaging techniques (PET, CT and MRI) may help to assess rupture risk. Elective repair of AAA with open surgery or endovascular aortic repair (EVAR) should be considered to prevent AAA rupture, although the morbidity and mortality associated with both techniques remain non-negligible.

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Fig. 1: AAAs.
Fig. 2: A speculative model of AAA progression.
Fig. 3: Conventional imaging of AAA.
Fig. 4: Functional imaging of AAA.
Fig. 5: Finite element analysis of AAA.
Fig. 6: Proposed surveillance protocol for patients with AAAs.
Fig. 7: History of the treatment of AAA.
Fig. 8: Open AAA repair surgery.
Fig. 9: Endovascular aortic repair.

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Acknowledgements

The authors thank A. Courtois for her help during the preparation of this manuscript, J. Roy, M. L. Liljeqvist and C. Gasser for their contribution to Fig. 5 and P. Bonnet for providing the figure on the surgical management of AAAs.

Reviewer information

Nature Reviews Disease Primers thank H.-H. Eckstein, S. Haulon, F. Moll, C. A. Nienaber, P. Norman, C. Zarins and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Liège, Belgium

    Natzi Sakalihasan & Jean-Olivier Defraigne

  2. Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium

    Natzi Sakalihasan, Jean-Olivier Defraigne & Alain Nchimi

  3. UMR 1148, INSERM Paris 7, Denis Diderot University, Xavier Bichat Hospital, Paris, France

    Jean-Baptiste Michel

  4. Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany

    Athanasios Katsargyris

  5. Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa

    Helena Kuivaniemi

  6. Department of Medical Imaging, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg

    Alain Nchimi

  7. Vascular Surgery Research Group, Imperial College London, London, UK

    Janet T. Powell

  8. Graduate School of Health and Welfare, Yamaguchi Prefectural University, Yamaguchi, Japan

    Koichi Yoshimura

  9. Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan

    Koichi Yoshimura

  10. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Rebecka Hultgren

  11. Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden

    Rebecka Hultgren

Authors
  1. Natzi Sakalihasan
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Contributions

Introduction (N.S. and J.T.P.); Epidemiology (R.H. and H.K.); Mechanisms/pathophysiology (J.-O.D., H.K. and J.-B.M.); Diagnosis, screening and prevention (N.S., A.N. and R.H.); Management (N.S., A.K., K.Y. and R.H.); Quality of life (A.K. and J.T.P.); Outlook (N.S., H.K. and J.T.P.); Overview of Primer (N.S. and R.H.).

Corresponding author

Correspondence to Natzi Sakalihasan.

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Related links

CDC WISQARS: http://www.cdc.gov/injury/wisqars/index.html

Swedish National Board of Health and Welfare: https://www.socialstyrelsen.se/publikationer2017/2017-9-11

UK Office for National Statistics: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath

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Sakalihasan, N., Michel, JB., Katsargyris, A. et al. Abdominal aortic aneurysms. Nat Rev Dis Primers 4, 34 (2018). https://doi.org/10.1038/s41572-018-0030-7

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