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Nat Rev Dis Primers. 2018 Oct 18;4(1):34. doi: 10.1038/s41572-018-0030-7.

Abdominal aortic aneurysms.

Author information

1
Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Liège, Belgium. nsaka@chu.ulg.ac.be.
2
Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium. nsaka@chu.ulg.ac.be.
3
UMR 1148, INSERM Paris 7, Denis Diderot University, Xavier Bichat Hospital, Paris, France.
4
Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
5
Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
6
Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Liège, Belgium.
7
Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium.
8
Department of Medical Imaging, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
9
Vascular Surgery Research Group, Imperial College London, London, UK.
10
Graduate School of Health and Welfare, Yamaguchi Prefectural University, Yamaguchi, Japan.
11
Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.
12
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
13
Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.

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.

PMID:
30337540
DOI:
10.1038/s41572-018-0030-7
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