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Epidemiology and contemporary management of abdominal aortic aneurysms

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Abstract

Abdominal aortic aneurysm (AAA) is most commonly defined as a maximal diameter of the abdominal aorta in excess of 3 cm in either anterior-posterior or transverse planes or, alternatively, as a focal dilation ≥ 1.5 times the diameter of the normal adjacent arterial segment. Risk factors for the development of AAA include age > 60, tobacco use, male gender, Caucasian race, and family history of AAA. Aneurysm growth and rupture risk appear to be associated with persistent tobacco use, female gender, and chronic pulmonary disease. The majority of AAAs are asymptomatic and detected incidentally on various imaging studies, including abdominal ultrasound, and computed tomographic angiography. Symptoms associated with AAA may include abdominal or back pain, thromboembolization, atheroembolization, aortic rupture, or development of an arteriovenous or aortoenteric fistula. The Screening Abdominal Aortic Aneurysms Efficiently (SAAAVE) Act provides coverage for a one-time screening abdominal ultrasound at age 65 for men who have smoked at least 100 cigarettes and women who have family history of AAA disease. Medical management is recommended for asymptomatic patients with AAAs < 5 cm in diameter and focuses on modifiable risk factors, including smoking cessation and blood pressure control. Primary indications for intervention in patients with AAA include development of symptoms, rupture, rapid aneurysm growth (> 5 mm/6 months), or presence of a fusiform aneurysm with maximum diameter of 5.5 cm or greater. Intervention for AAA includes conventional open surgical repair and endovascular aortic stent graft repair.

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References

  1. Chaikof EL, Brewster DC, Dalman RL, et al. (2009) SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg 50:880–896

    Article  PubMed  Google Scholar 

  2. Ouriel K, Green RM, Donayre C, et al. (1992) An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture. J Vasc Surg 15:12–18

    Article  CAS  PubMed  Google Scholar 

  3. Hirsch AT, Haskal ZJ, Hertzer NR, et al. (2006) ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 113:463–654

    Article  Google Scholar 

  4. Collin J, Araujo L, Walton J, Lindsell D (1988) Oxford screening programme for abdominal aortic aneurysm in men aged 65 to 74 years. Lancet 2:613–615

    Article  CAS  PubMed  Google Scholar 

  5. Singh K, Bonaa KH, Jacobsen BK, Bjork L, Solberg S (2001) Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: the Tromso Study. Am J Epidemiol 154:236–244

    Article  CAS  PubMed  Google Scholar 

  6. Boll AP, Verbeek AL, van de Lisdonk EH, van der Vliet JA (1998) High prevalence of abdominal aortic aneurysm in a primary care screening programme. Br J Surg 85:1090–1094

    Article  CAS  PubMed  Google Scholar 

  7. Pleumeekers HJ, Hoes AW, van der Does E, et al. (1995) Aneurysms of the abdominal aorta in older adults. The Rotterdam Study. Am J Epidemiol 142:1291–1299

    Article  CAS  PubMed  Google Scholar 

  8. McFarlane MJ (1991) The epidemiologic necropsy for abdominal aortic aneurysm. JAMA 265:2085–2088

    Article  CAS  PubMed  Google Scholar 

  9. Darling RC, Messina CR, Brewster DC, Ottinger LW (1977) Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circulation 56:161–164

    Google Scholar 

  10. Powell JT, Greenhalgh RM (2003) Clinical practice. Small abdominal aortic aneurysms. N Engl J Med 348:1895–1901

    Article  PubMed  Google Scholar 

  11. Scott RA, Ashton HA, Kay DN (1991) Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years. Br J Surg 78:1122–1125

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Wanhainen A (2008) How to define an abdominal aortic aneurysm–influence on epidemiology and clinical practice. Scand J Surg 97(2):105–109

    Article  CAS  PubMed  Google Scholar 

  14. Brady AR, Thompson SG, Fowkes FG, et al. (2004) Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 110:16–21

    Article  PubMed  Google Scholar 

  15. Brown LC, Powell JT (1999) Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg 230:289–296

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lederle FA, Nelson DB, Joseph AM (2003) Smokers’ relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review. J Vasc Surg 38:329–334

    Article  PubMed  Google Scholar 

  17. Kent KC, Zwolak RM, Egorova NN, et al. (2010) Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 52:539–548

    Article  PubMed  Google Scholar 

  18. Wilmink TB, Quick CR, Day NE (1999) The association between cigarette smoking and abdominal aortic aneurysms. J Vasc Surg 30:1099–1105

    Article  CAS  PubMed  Google Scholar 

  19. Lederle FA, Johnson GR, Wilson SE, et al. (1997) Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med 126:441–449

    Article  CAS  PubMed  Google Scholar 

  20. Salem MK, Rayt HS, Hussey G, et al. (2009) Should Asian men be included in abdominal aortic aneurysm screening programmes? Eur J Vasc Endovasc Surg 38:748–749

    Article  CAS  PubMed  Google Scholar 

  21. Blanchard JF, Armenian HK, Friesen PP (2000) Risk factors for abdominal aortic aneurysm: results of a case-control study. Am J Epidemiol 151:575–583

    Article  CAS  PubMed  Google Scholar 

  22. Fleming C, Whitlock EP, Beil TL, Lederle FA (2005) Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 142:203–211

    Article  PubMed  Google Scholar 

  23. Johansen K, Koepsell T (1986) Familial tendency for abdominal aortic aneurysms. JAMA 256:1934–1936

    Article  CAS  PubMed  Google Scholar 

  24. Larsson E, Granath F, Swedenborg J, Hultgren R (2009) A population-based case-control study of the familial risk of abdominal aortic aneurysm. J Vasc Surg 49:47–50

    Article  PubMed  Google Scholar 

  25. Majumder PP, St Jean PL, Ferrell RE, Webster MW, Steed DL (1991) On the inheritance of abdominal aortic aneurysm. Am J Hum Genet 48:164–170

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Kuivaniemi H, Shibamura H, Arthur C, et al. (2003) Familial abdominal aortic aneurysms: collection of 233 multiplex families. J Vasc Surg 37:340–345

    Article  PubMed  Google Scholar 

  27. Verloes A, Sakalihasan N, Koulischer L, Limet R (1995) Aneurysms of the abdominal aorta: familial and genetic aspects in three hundred thirteen pedigrees. J Vasc Surg 21:646–655

    Article  CAS  PubMed  Google Scholar 

  28. Whitehouse WM Jr, Wakefield TW, Graham LM, et al. (1983) Limb-threatening potential of arteriosclerotic popliteal artery aneurysms. Surgery 93:694–699

    PubMed  Google Scholar 

  29. Graham LM, Zelenock GB, Whitehouse WM Jr, et al. (1980) Clinical significance of arteriosclerotic femoral artery aneurysms. Arch Surg 115:502–507

    Article  CAS  PubMed  Google Scholar 

  30. MacSweeney ST, O’Meara M, Alexander C, et al. (1993) High prevalence of unsuspected abdominal aortic aneurysm in patients with confirmed symptomatic peripheral or cerebral arterial disease. Br J Surg 80:582–584

    Article  CAS  PubMed  Google Scholar 

  31. Baxter BT, Terrin MC, Dalman RL (2008) Medical management of small abdominal aortic aneurysms. Circulation 117:1883–1889

    Article  PubMed  PubMed Central  Google Scholar 

  32. Shantikumar S, Ajjan R, Porter KE, Scott DJ (2010) Diabetes and the abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 39:200–207

    Article  CAS  PubMed  Google Scholar 

  33. Ihara M, Urata H, Kinoshita A, et al. (1999) Increased chymase-dependent angiotensin II formation in human atherosclerotic aorta. Hypertension 33:1399–1405

    Article  CAS  PubMed  Google Scholar 

  34. Koch AE, Haines GK, Rizzo RJ, et al. (1990) Human abdominal aortic aneurysms. Immunophenotypic analysis suggesting an immune-mediated response. Am J Pathol 137:1199–1213

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Miller FJ Jr, Sharp WJ, Fang X, et al. (2002) Oxidative stress in human abdominal aortic aneurysms: a potential mediator of aneurysmal remodeling. Arterioscler Thromb Vasc Biol 22:560–565

    Article  CAS  PubMed  Google Scholar 

  36. Schonbeck U, Sukhova GK, Gerdes N, Libby P (2002) T(H)2 predominant immune responses prevail in human abdominal aortic aneurysm. Am J Pathol 161:499–506

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Watanabe N, Arase H, Kurasawa K, et al. (1997) Th1 and Th2 subsets equally undergo Fas-dependent and -independent activation-induced cell death. Eur J Immunol 27:1858–1864

    Article  CAS  PubMed  Google Scholar 

  38. Shimizu K, Shichiri M, Libby P, Lee RT, Mitchell RN (2004) Th2-predominant inflammation and blockade of IFN-gamma signaling induce aneurysms in allografted aortas. J Clin Invest 114:300–308

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  40. Davies MJ (1998) Aortic aneurysm formation: lessons from human studies and experimental models. Circulation 98:193–195

    Article  CAS  PubMed  Google Scholar 

  41. Grange JJ, Davis V, Baxter BT (1997) Pathogenesis of abdominal aortic aneurysm: an update and look toward the future. Cardiovasc Surg 5:256–265

    Article  CAS  PubMed  Google Scholar 

  42. Thompson AR, Cooper JA, Ashton HA, Hafez H (2010) Growth rates of small abdominal aortic aneurysms correlate with clinical events. Br J Surg 97:37–44

    Article  CAS  PubMed  Google Scholar 

  43. Schouten O, van Laanen JH, Boersma E, et al. (2006) Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. Eur J Vasc Endovasc Surg 32:21–26

    Article  CAS  PubMed  Google Scholar 

  44. Santilli SM, Littooy FN, Cambria RA, et al. (2002) Expansion rates and outcomes for the 3.0-cm to the 3.9-cm infrarenal abdominal aortic aneurysm. J Vasc Surg 35:666–671

    Article  PubMed  Google Scholar 

  45. Lindholt JS, Heickendorff L, Antonsen S, Fasting H, Henneberg EW (1998) Natural history of abdominal aortic aneurysm with and without coexisting chronic obstructive pulmonary disease. J Vasc Surg 28:226–233

    Article  CAS  PubMed  Google Scholar 

  46. Stonebridge PA, Draper T, Kelman J, et al. (1996) Growth rate of infrarenal aortic aneurysms. Eur J Vasc Endovasc Surg 11:70–73

    Article  CAS  PubMed  Google Scholar 

  47. Solberg S, Singh K, Wilsgaard T, Jacobsen BK (2005) Increased growth rate of abdominal aortic aneurysms in women. The Tromso study. Eur J Vasc Endovasc Surg 29:145–149

    Article  CAS  PubMed  Google Scholar 

  48. Mofidi R, Goldie VJ, Kelman J, et al. (2007) Influence of sex on expansion rate of abdominal aortic aneurysms. Br J Surg 94:310–314

    Article  CAS  PubMed  Google Scholar 

  49. Vega de Ceniga M, Gomez R, Estallo L, et al. (2006) Growth rate and associated factors in small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 31:231–236

    Article  CAS  PubMed  Google Scholar 

  50. Chang JB, Stein TA, Liu JP, Dunn ME (1997) Risk factors associated with rapid growth of small abdominal aortic aneurysms. Surgery 121:117–122

    Article  CAS  PubMed  Google Scholar 

  51. Bhak RH, Wininger M, Johnson GR, Lederle FA, Messina LM, Ballard DJ, Wilson SE, Aneurysm D; Management Study G (2015) Factors associated with small abdominal aortic aneurysm expansion rate. JAMA Surg 150:44–50

    Article  Google Scholar 

  52. Cronenwett JL, Sargent SK, Wall MH, et al. (1990) Variables that affect the expansion rate and outcome of small abdominal aortic aneurysms. J Vasc Surg 11:260–268

    Article  CAS  PubMed  Google Scholar 

  53. Propanolol Aneurysm Trial I (2002) Propranolol for small abdominal aortic aneurysms: results of a randomized trial. J Vasc Surg 35:72–79

    Article  Google Scholar 

  54. Norman PE, Jamrozik K, Lawrence-Brown MM, et al. (2004) Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ 329:1259

    Article  PubMed  PubMed Central  Google Scholar 

  55. Schewe CK, Schweikart HP, Hammel G, et al. (1994) Influence of selective management on the prognosis and the risk of rupture of abdominal aortic aneurysms. Clin Investig 72:585–591

    Article  CAS  PubMed  Google Scholar 

  56. Yoshimura K, Nagasawa A, Kudo J, et al. (2015) Inhibitory effect of statins on inflammation-related pathways in human abdominal aortic aneurysm tissue. Int J Mol Sci 16:11213–11228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Piechota-Polanczyk A, Goraca A, Demyanets S, et al. (2012) Simvastatin decreases free radicals formation in the human abdominal aortic aneurysm wall via NF-kappaB. Eur J Vasc Endovasc Surg 44:133–137

    Article  CAS  PubMed  Google Scholar 

  58. Ferguson CD, Clancy P, Bourke B, et al. (2010) Association of statin prescription with small abdominal aortic aneurysm progression. Am Heart J 159:307–313

    Article  PubMed  PubMed Central  Google Scholar 

  59. Schlosser FJ, Tangelder MJ, Verhagen HJ, et al. (2008) Growth predictors and prognosis of small abdominal aortic aneurysms. J Vasc Surg 47:1127–1133

    Article  PubMed  Google Scholar 

  60. Guessous I, Periard D, Lorenzetti D, Cornuz J, Ghali WA (2008) The efficacy of pharmacotherapy for decreasing the expansion rate of abdominal aortic aneurysms: a systematic review and meta-analysis. PLoS ONE 3:e1895

    Article  PubMed  PubMed Central  Google Scholar 

  61. Curci JA, Mao D, Bohner DG, et al. (2000) Preoperative treatment with doxycycline reduces aortic wall expression and activation of matrix metalloproteinases in patients with abdominal aortic aneurysms. J Vasc Surg 31:325–342

    Article  CAS  PubMed  Google Scholar 

  62. Mosorin M, Juvonen J, Biancari F, et al. (2001) Use of doxycycline to decrease the growth rate of abdominal aortic aneurysms: a randomized, double-blind, placebo-controlled pilot study. J Vasc Surg 34:606–610

    Article  CAS  PubMed  Google Scholar 

  63. Baxter BT, Pearce WH, Waltke EA, et al. (2002) Prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms: report of a prospective (Phase II) multicenter study. J Vasc Surg 36:1–12

    Article  PubMed  Google Scholar 

  64. Moll FL, Powell JT, Fraedrich G, et al. (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 41(Suppl 1):S1–S58

    Google Scholar 

  65. Conway KP, Byrne J, Townsend M, Lane IF (2001) Prognosis of patients turned down for conventional abdominal aortic aneurysm repair in the endovascular and sonographic era: Szilagyi revisited? J Vasc Surg 33:752–757

    Article  CAS  PubMed  Google Scholar 

  66. Brewster DC, Cronenwett JL, Hallett JW, Jr., et al. (2003) Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 37:1106–1117

    Article  Google Scholar 

  67. Fillinger MF, Raghavan ML, Marra SP, Cronenwett JL, Kennedy FE (2002) In vivo analysis of mechanical wall stress and abdominal aortic aneurysm rupture risk. J Vasc Surg 36:589–597

    Article  PubMed  Google Scholar 

  68. Gasser TC, Nchimi A, Swedenborg J, et al. (2014) A novel strategy to translate the biomechanical rupture risk of abdominal aortic aneurysms to their equivalent diameter risk: method and retrospective validation. Eur J Vasc Endovasc Surg 47:288–295

    Article  CAS  PubMed  Google Scholar 

  69. Kleinstreuer C, Li Z (2006) Analysis and computer program for rupture-risk prediction of abdominal aortic aneurysms. Biomed Eng Online 5:19

    Article  PubMed  PubMed Central  Google Scholar 

  70. Stringfellow MM, Lawrence PF, Stringfellow RG (1987) The influence of aorta-aneurysm geometry upon stress in the aneurysm wall. J Surg Res 42:425–433

    Article  CAS  PubMed  Google Scholar 

  71. Rabkin SW (2016) The effect of nicotine and tobacco on aortic matrix metalloproteinases in the production of aortic aneurysm. Curr Vasc Pharmacol 14:514–522

    Article  CAS  PubMed  Google Scholar 

  72. Smart CJ, Fisher RK (2007) Influence of sex on expansion rate of abdominal aortic aneurysms. Br J Surg 94:1041–1042

    Article  CAS  PubMed  Google Scholar 

  73. Gadowski GR, Pilcher DB, Ricci MA (1994) Abdominal aortic aneurysm expansion rate: effect of size and beta-adrenergic blockade. J Vasc Surg 19:727–731

    Article  CAS  PubMed  Google Scholar 

  74. Bengtsson H, Bergqvist D, Ekberg O, Ranstam J (1993) Expansion pattern and risk of rupture of abdominal aortic aneurysms that were not operated on. Eur J Surg 159:461–467

    CAS  PubMed  Google Scholar 

  75. Cron DC, Coleman DM, Sheetz KH, Englesbe MJ, Waits SA (2014) Aneurysms in abdominal organ transplant recipients. J Vasc Surg 59:594–598

    Article  PubMed  Google Scholar 

  76. Vantrimpont PJ, van Dalen BM, van Riemsdijk-van Overbeeke IC, Maat AP, Balk AH (2004) Abdominal aortic aneurysms after heart transplantation. J Heart Lung Transplant 23:171–177

    Article  PubMed  Google Scholar 

  77. Cronenwett JL, Murphy TF, Zelenock GB, et al. (1985) Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms. Surgery 98:472–483

    CAS  PubMed  Google Scholar 

  78. Fink HA, Lederle FA, Roth CS, et al. (2000) The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med 160(6):833–836

    Article  CAS  PubMed  Google Scholar 

  79. Crawford CM, Hurtgen-Grace K, Talarico E, Marley J (2003) Abdominal aortic aneurysm: an illustrated narrative review. J Manip Physiol Ther 26:184–195

    Article  Google Scholar 

  80. Akkersdijk GJ, van Bockel JH (1998) Ruptured abdominal aortic aneurysm: initial misdiagnosis and the effect on treatment. Eur J Surg 164:29–34

    Article  CAS  PubMed  Google Scholar 

  81. Lee TY, Korn P, Heller JA, et al. (2002) The cost-effectiveness of a “quick-screen” program for abdominal aortic aneurysms. Surgery 132:399–407

    Article  PubMed  Google Scholar 

  82. Beales L, Wolstenhulme S, Evans JA, West R, Scott DJ (2011) Reproducibility of ultrasound measurement of the abdominal aorta. Br J Surg 98:1517–1525

    Article  CAS  PubMed  Google Scholar 

  83. Scott RA, Bridgewater SG, Ashton HA (2002) Randomized clinical trial of screening for abdominal aortic aneurysm in women. Br J Surg 89:283–285

    Article  CAS  PubMed  Google Scholar 

  84. Lindholt JS, Juul S, Fasting H, Henneberg EW (2005) Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ 330:750

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  Google Scholar 

  86. Cosford PA, Leng GC (2007) Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev (2):CD002945.

  87. United Kingdom Small Aneurysm Trial P, Powell JT, Brady AR, et al. (2002) Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 346:1445–1452

    Article  Google Scholar 

  88. Lederle FA, Wilson SE, Johnson GR, et al. (2002) Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 346:1437–1444

    Article  Google Scholar 

  89. Cao P, Collaborators CT (2005) Comparison of surveillance vs Aortic Endografting for Small Aneurysm Repair (CAESAR) trial: study design and progress. Eur J Vasc Endovasc Surg 30(3):245–251

    Article  CAS  PubMed  Google Scholar 

  90. Katz DA, Littenberg B, Cronenwett JL (1992) Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting. JAMA 268:2678–2686

    Article  CAS  PubMed  Google Scholar 

  91. Isselbacher EM (2005) Thoracic and abdominal aortic aneurysms. Circulation 111:816–828

    Article  PubMed  Google Scholar 

  92. Sweeting MJ, Thompson SG, Brown LC, Powell JT, Collaborators R (2012) Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg 99:655–665

    Article  CAS  PubMed  Google Scholar 

  93. Sukhija R, Aronow WS, Sandhu R, Kakar P, Babu S (2006) Mortality and size of abdominal aortic aneurysm at long-term follow-up of patients not treated surgically and treated with and without statins. Am J Cardiol 97:279–280

    Article  PubMed  Google Scholar 

  94. Rughani G, Robertson L, Clarke M (2012) Medical treatment for small abdominal aortic aneurysms. Cochrane Database Syst Rev (9):CD009536

  95. Vammen S, Lindholt JS, Ostergaard L, Fasting H, Henneberg EW (2001) Randomized double-blind controlled trial of roxithromycin for prevention of abdominal aortic aneurysm expansion. Br J Surg 88(8):1066–1072

    Article  CAS  PubMed  Google Scholar 

  96. Schwarze ML, Shen Y, Hemmerich J, Dale W (2009) Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006. J Vasc Surg 50:722–729

    Article  PubMed  Google Scholar 

  97. Chadi SA, Rowe BW, Vogt KN, et al. (2012) Trends in management of abdominal aortic aneurysms. J Vasc Surg 55:924–928

    Article  PubMed  Google Scholar 

  98. Lovegrove RE, Javid M, Magee TR, Galland RB (2008) A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 95:677–684

    Article  CAS  PubMed  Google Scholar 

  99. Greenhalgh RM, Brown LC, Kwong GP, et al. (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364(9437):843–848

    Article  CAS  PubMed  Google Scholar 

  100. Prinssen M, Verhoeven EL, Buth J, et al. (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618

    Article  CAS  PubMed  Google Scholar 

  101. Lederle FA, Freischlag JA, Kyriakides TC, et al. (2012) Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med 367:1988–1997

    Article  CAS  Google Scholar 

  102. Schermerhorn ML, O’Malley AJ, Jhaveri A, et al. (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474

    Article  CAS  PubMed  Google Scholar 

  103. Matsumura JS, Brewster DC, Makaroun MS, Naftel DC (2003) A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 37:262–271

    Article  PubMed  Google Scholar 

  104. Greenberg RK, Chuter TA, Cambria RP, Sternbergh WC 3rd, Fearnot NE (2008) Zenith abdominal aortic aneurysm endovascular graft. J Vasc Surg 48:1–9

    Article  PubMed  Google Scholar 

  105. Carpenter JP (2006) The Powerlink bifurcated system for endovascular aortic aneurysm repair: four-year results of the US multicenter trial. J Cardiovasc Surg (Torino) 47(3):239–243

    CAS  Google Scholar 

  106. Chambers D, Epstein D, Walker S, et al. (2009) Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model. Health Technol Assess 13(48):1–189, 215–318, iii. https://doi.org/10.3310/hta13480

  107. Sicard GA, Zwolak RM, Sidawy AN, et al. (2006) Endovascular abdominal aortic aneurysm repair: long-term outcome measures in patients at high-risk for open surgery. J Vasc Surg 44:229–236

    Article  Google Scholar 

  108. Becquemin JP (2009) The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm. J Vasc Surg 50:222–224

    Article  PubMed  Google Scholar 

  109. Paravastu SC, Jayarajasingam R, Cottam R, et al. (2014) Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev:CD004178.

  110. United Kingdom ETI, Greenhalgh RM, Brown LC, et al. (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871

    Article  CAS  Google Scholar 

  111. Burgers LT, Vahl AC, Severens JL, et al. (2016) Cost-effectiveness of elective endovascular aneurysm repair versus open surgical repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 52:29–40

    Article  CAS  PubMed  Google Scholar 

  112. Brown PM, Sobolev B, Zelt DT (2003) Selective management of abdominal aortic aneurysms smaller than 5.0 cm in a prospective sizing program with gender-specific analysis. J Vasc Surg 38(4):762–765

    Article  PubMed  Google Scholar 

  113. Winterborn RJ, Amin I, Lyratzopoulos G, et al. (2009) Preferences for endovascular (EVAR) or open surgical repair among patients with abdominal aortic aneurysms under surveillance. J Vasc Surg 49:576–581

    Article  PubMed  Google Scholar 

  114. Wallace GA, Starnes BW, Hatsukami TS, et al. (2013) Favorable discharge disposition and survival after successful endovascular repair of ruptured abdominal aortic aneurysm. J Vasc Surg 57:1495–1502

    Article  PubMed  Google Scholar 

  115. Veith FJ, Lachat M, Mayer D, et al. (2009) Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Ann Surg 250:818–824

    Article  PubMed  Google Scholar 

  116. Starnes BW, Quiroga E, Hutter C, et al. (2010) Management of ruptured abdominal aortic aneurysm in the endovascular era. J Vasc Surg 51:9–17

    Article  PubMed  Google Scholar 

  117. Davenport DL, O’Keeffe SD, Minion DJ, et al. (2010) Thirty-day NSQIP database outcomes of open versus endoluminal repair of ruptured abdominal aortic aneurysms. J Vasc Surg 51:305–309

    Article  PubMed  Google Scholar 

  118. Mandawat A, Mandawat A, Sosa JA, Muhs BE, Indes JE (2012) Endovascular repair is associated with superior clinical outcomes in patients transferred for treatment of ruptured abdominal aortic aneurysms. J Endovasc Ther 19:88–95

    Article  PubMed  Google Scholar 

  119. Hinchliffe RJ, Powell JT, Cheshire NJ, Thompson MM (2009) Endovascular repair of ruptured abdominal aortic aneurysm: A strategy in need of definitive evidence. J Vasc Surg 49:1077–1080

    Article  PubMed  Google Scholar 

  120. Saqib N, Park SC, Park T, et al. (2012) Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair. J Vasc Surg 56:614–619

    Article  PubMed  Google Scholar 

  121. Mastracci TM, Garrido-Olivares L, Cina CS, Clase CM (2008) Endovascular repair of ruptured abdominal aortic aneurysms: a systematic review and meta-analysis. J Vasc Surg 47:214–221

    Article  PubMed  Google Scholar 

  122. Ullery BW, Tran K, Chandra V, et al. (2015) Association of an endovascular-first protocol for ruptured abdominal aortic aneurysms with survival and discharge disposition. JAMA Surg 150:1058–1065

    Article  PubMed  Google Scholar 

  123. Oyague KS, Mubarak OA, Nowak LR, et al. (2015) Endovascular repair of ruptured and symptomatic abdominal aortic aneurysms using a structured protocol in a community teaching hospital. Ann Vasc Surg 29:76–83

    Article  PubMed  Google Scholar 

  124. Mehta M, Taggert J, Darling RC 3rd, et al. (2006) Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 44:1–8

    Article  CAS  PubMed  Google Scholar 

  125. Wilderman M, Sanchez LA (2009) Fenestrated grafts or debranching procedures for complex abdominal aortic aneurysms. Perspect Vasc Surg Endovasc Ther 21:13–18

    Article  PubMed  Google Scholar 

  126. Ultee KHJ, Zettervall SL, Soden PA, et al. (2017) Perioperative outcome of endovascular repair for complex abdominal aortic aneurysms. J Vasc Surg 65:1567–1575

    Article  PubMed  PubMed Central  Google Scholar 

  127. Mastracci TM, Eagleton MJ, Kuramochi Y, Bathurst S, Wolski K (2015) Twelve-year results of fenestrated endografts for juxtarenal and group IV thoracoabdominal aneurysms. J Vasc Surg 61:355–364

    Article  PubMed  Google Scholar 

  128. Oderich GS, Ribeiro M, Hofer J, et al. (2017) Prospective, nonrandomized study to evaluate endovascular repair of pararenal and thoracoabdominal aortic aneurysms using fenestrated-branched endografts based on supraceliac sealing zones. J Vasc Surg 65:1249–1259

    Article  PubMed  Google Scholar 

  129. Farber MA, Eagleton MJ, Mastracci TM, et al. (2017) Results from multiple prospective single-center clinical trials of the off-the-shelf p-Branch fenestrated stent graft. J Vasc Surg 66:982–990

    Article  PubMed  Google Scholar 

  130. Lee JT, Greenberg JI, Dalman RL (2012) Early experience with the snorkel technique for juxtarenal aneurysms. J Vasc Surg 55(4):935–946

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Providence Heart and Vascular Institute, 5050 N.E. Hoyt St., Suite 511, Portland, OR, 97213, USA

    Brant W. Ullery

  2. Department of Radiology, Stanford University, Stanford, CA, USA

    Richard L. Hallett & Dominik Fleischmann

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  1. Brant W. Ullery
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  2. Richard L. Hallett
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  3. Dominik Fleischmann
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Correspondence to Brant W. Ullery.

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Informed consent was obtained from all individual participants included in the study.

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Ullery, B.W., Hallett, R.L. & Fleischmann, D. Epidemiology and contemporary management of abdominal aortic aneurysms. Abdom Radiol 43, 1032–1043 (2018). https://doi.org/10.1007/s00261-017-1450-7

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