Small aneurysms of abdominal aorta – is it time to change our approach?

Czech version

Authors: P. Vařejka; A. Linhart
Published in: Kardiol Rev Int Med 2010, 12(4): 171-174
Category: Angiological Symposium

Overview

Abdominal aortic aneurysm is a serious vascular disease, typically occurring in men over 60 years of age with a history of active smoking. The condition is associated with a risk of rapture that is fatal in 90% of cases. At present, there is a consensus with respect to indicating abdominal aortic aneurysms with a maximum diameter of 55 mm or more for surgery or endovascular intervention. Smaller aneurysms are usually managed conservatively with a surgery planned for the time when the diameter of 55 mm is reached or if the rate of aneurysm sac expansion is 1 cm per 12 months. This approach is based on the results of randomized studies where open surgery was the only alternative treatment modality used. Endovascular techniques, burdened by fewer procedural complications, are fast finding their place in the treatment of these patients and, consequently, patients with smaller aneurysm diameters could profit from an early intervention.

Keywords:
abdominal aortic aneurysm – stent-graft – open surgery

Sources

1. Leonardo R. History of Surgery. New York: Froben Press 1943.

2. Dubost C, Allary M, Oeconomos N. Resection of an aneurysm of the abdominal aorta: Reestablishment of the continuity by a preserved human arterial graft, with result after five months. Arch Surg 1952; 64: 405–408.

3. Gillum RF. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol 1995; 48: 1289–1298.

4. Anderson PL, Arons RR, Moskovitz AJ et al. A statewide experience with endovascular abdominal aortic aneurysm repair: rapid diffusion with excellent early results. J Vasc Surg 2004; 39: 10–19.

5. Greenhalgh RM, Brown LC, Kwong GP et al. EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day opreative mortality results: randomised controll trial. Lancet 2004; 364: 843–848.

6. Prinssen M, Verhoeven ELG, Buth J et al. A randomised trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351: 1607–1618.

7. Lederle FA, Wilson SE, Johnson GR et al. Aneurysm Detection and Management Veterans Affairs Cooperative Study Group. Immediate repair compared with surveillance of small abdominal aortic aneurysm. N Engl J Med 2002; 346: 1437–1444.

8. Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. Lancet 1998; 352: 1694–1655.

9. Bengtsson H, Bergqvist D, Ekberg O et al. A population based screening of abdominal aortic aneurysms (AAA). Eur J Vascr Surg 1991; 5: 53–57.

10. Smith FC, Grimshaw GM, Paterson IS et al. Ultrasonographic screening for abdominal aortic aneurysm in an urban community. Brit J Surg 1993; 80: 1406–1409.

11. Morris GE, Hubbard CS, Quick CR. An abdominal aortic aneurysm screening programme for all males over the age of 50 years. Eur J Vasc Surg 1994; 8: 156–160.

12. Simoni G, Pastorino C, Perrone R et al. Screening for abdominal aortic aneurysms and associated risk factors in a general population. Eur J Vasc Endovasc Surg 1995; 10: 207–210.

13. Lindholt JS, Henneberg EW, Fasting H et al. Mass or high-risk screening for abdominal aortic aneurysm. Br J Surg 1997; 84: 40–42.

14. Ashton HA, Buxton MJ, Day NE et al. Multicentre Aneurysm Screening Study Group. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 2002; 360: 1531–1539.

15. Norman PE, Jamrozik K, Lawrence-Brown MM et al. Western Australian randomized controlled trial of screening for abdominal aortic aneurysm. Brit J Surg 2003; 90: 492.

16. Lederle FA, Johnson GR, Wilson SE et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Inter Med 2000; 160: 1425–1430.

17. Halloran BG, Davis VA, McManus BM et al. Localization of aortic disease is associated with intrinsic differences in aortic structure. J Surg Res 1995; 59: 17–22.

18. Grange JJ, Davis V, Baxter BT. Pathogenesis of abdominal aortic aneurysm: An update and look toward the future. Cardiovasc Surg 1997; 5: 256–265.

19. Patel MI, Hardman DT, Fisher CM et al. Current views on the pathogenesis of abdominal aortic aneurysms. J Am Coll Surg 1995; 181: 371–382.

20. Hunter GC, Smyth SH, Aguirre ML et al. Incidence and histologic characteristics of blebs in patients with abdominal aortic aneurysms. J Vasc Surg 1996; 24: 93–101.

21. McMillan WD, Tamarina NA, Cipollone M et al. Size matters: The relationship between MMP-9 expression and aortic diameter. Circulation 1997; 96: 2228–2232.

22. van der Vliet JA, Boll AP. Abdominal aortic aneurysm. Lancet 1997; 349: 863–866.

23. Darling RC 3rd, Brewster DC, Darling RC et al. Are familial abdominal aortic aneurysms different? J Vasc Surg 1989; 10: 39–43.

24. Johansen K, Koepsell T. Familial tendency for abdominal aortic aneurysms. JAMA 1986; 256: 1934–1936.

25. Verloes A, Sakalihasan N, Koulischer L et al. Aneurysms of the abdominal aorta: Familial and genetic aspects in three hundred thirteen pedigrees. J Vasc Surg 1995; 21: 646–455.

26. Webster MW, Ferrell RE, St Jean PL et al. Ultrasound screening of first-degree relatives of patients with an abdominal aortic aneurysm. J Vasc Surg 1991; 13: 9–13.

27. Lederle FA, Simel DL. The rational clinical examination: Does this patient have abdominal aortic aneurysm? JAMA 1999; 281: 77–82.

28. Hinchliffe RJ, Yusuf SW, Macierewicz JA et al. Endovascular repair of ruptured abdominal aortic aneurysm – a challenge to open repair? Results of a single centre experience in 20 patients. Eur J Vasc Endovasc Surg 2001; 22: 528–534.

29. Lederle FA, Johnson GR, Wilson SE et al. Veterans Affairs Cooperative Study #417 Investigators. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA 2002; 287: 2968–2972.

30. Wilt TJ, Lederle FA, Macdonald R et al. Comparison of endovascular and open surgical repairs for abdominal aortic aneurysm. Evid Rep Technol Assess (Full Rep) 2006; 144: 1–113.

31. Ouriel K, Siravastava SD, Sarac TP et al. Disparate outcome after endovascular treatment of small versus large abdominal aortic aneurysm. J Vasc Surg 2003; 37: 1206–1212.

32. Zarins CK, Crabtree T, Bloch DA et al. Endovascular aneurysm repair at 5 years: does aneurysm diameter predict outcome? J Vasc Surg 2006; 44: 920–930.

Labels

Paediatric cardiology Internal medicine Cardiac surgery Cardiology

Diagnostics and treatment of peripheral arterial disease in the Czech Republic (results of the MOET ICHDK [MOET PAD] – Monitoring of an Effective Therapy of Peripheral Arterial Disease – project)

News from the 2010 guidelines for the treatment of patients with atrial fibrillation

Is there a sufficient evidence for cardioprotective effects of mild wine consumption on cardiovascular diseases?

Rare popliteal artery diseases

Aortitis – an inflammation of the aortic wall

Thrombolytic therapy of acute central retinal artery occlusion

Unusual cause of acute limb ischemia – stent fracture

Article was published in

Cardiology Review

2010 Issue 4