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Abdominal Aortic Aneurysms in Patients with Diabetes

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Diabetes and Peripheral Vascular Disease

Part of the book series: Contemporary Diabetes ((CDI))

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Abstract

Patients with abdominal aortic aneurysms (AAAs) share many of the traditional risk factors for atherosclerosis with the notable exception of diabetes, as diabetes is paradoxically protective against AAA formation. Furthermore, if diabetics develop AAAs, they have a slower rate of AAA progression. Speculation as to the mechanism(s) involved in these protective features is multifactorial, including (1) a thicker aortic wall in diabetics as compared to non-diabetics; (2) decreased levels of matrix metalloproteinases (MMPs), especially MMP2 and 9, in the diabetic aorta with relative preservation of elastin fibers in the medial layer; and (3) increased plasminogen activator inhibitor-1 activity in diabetics. However, once AAA repair is indicated, diabetes is no longer protective, and the surgical team must consider complications associated with diabetes. Comorbidities that have the greatest impact on AAA repair include cardiac dysfunction, renal impairment, and complications associated with increased atherosclerotic disease. AAAs may be repaired either endovascularly or open with efforts made to preserve renal function. While diabetes alone is not associated with poor postoperative outcomes, comorbid conditions associated with diabetes, such as renal failure, are linked with increased mortality. Blood glucose concentrations must be carefully controlled perioperatively to decrease wound complications. Nephrotoxic agents, especially iodinated contrast, should be avoided if possible, and alternative methods of surveillance may include ultrasound and noncontrast computed tomography. While diabetes is protective from developing AAAs, clinicians caring for patients with diabetes who undergo AAA repair should be aware of the increased risk of perioperative complications.

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Authors and Affiliations

  1. Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, 800679, Charlottesville, VA, 22908-0679, USA

    William F. Johnston M.D. & Gilbert R. Upchurch Jr. M.D.

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  1. William F. Johnston M.D.
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  2. Gilbert R. Upchurch Jr. M.D.
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Correspondence to Gilbert R. Upchurch Jr. M.D. .

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Editors and Affiliations

  1. Columbia University College of Physician, Division of Vascular Surgery, New York Presbyterian Hospital, 72 East 93rd Street, Apt 2 AB, New York, 10128, New York, USA

    Gautam V. Shrikhande

  2. Columbia University College of Physician, Division of Vascular Surgery, New York Presbyterian Hospital, 161 Fort Washington Ave. Suite 535, New York, 10032, New York, USA

    James F. McKinsey

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Johnston, W.F., Upchurch, G.R. (2012). Abdominal Aortic Aneurysms in Patients with Diabetes. In: Shrikhande, G., McKinsey, J. (eds) Diabetes and Peripheral Vascular Disease. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-158-5_15

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