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Abdominal Aortic Aneurysms

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Diseases of the Aorta

Abstract

Abdominal aortic aneurysms (AAA) are a major cause of morbidity and mortality. Rupture of an AAA is a catastrophic event that leads to death in 80–90% of patients overall, including 50–70% of patients that reach medical attention. AAA can be described by their location and/or morphologic features. The pathophysiology is driven by abnormalities in the connective tissue of the aortic wall, namely elastin. While abnormalities in elastin lead to aneurysm formation, disruption of collagen in the aortic wall is what ultimately leads to rupture.

Major risk factors for this entity include smoking, advanced age, male gender, and family history. There are a variety of modalities that are used to image abdominal aortic aneurysms. Most commonly, ultrasound is used and is recommended by several societies for screening patients at risk of this disease. While behavioral modifications are recommended in patients with AAA to improve overall cardiac health, the mainstay of management is aneurysm repair. Generally, repair of an AAA is considered once it is ≥5.0 cm. Current options for intervention include open surgical repair and endovascular aneurysm repair (EVAR). Large randomized trials to date thus far suggest that while EVAR has improved perioperative mortality, long-term mortality outcomes appear to be better in patients that undergo surgical repair. Surveillance imaging with CT is recommended in patients that undergo open surgical repair of an AAA to assess for paranastomotic aneurysm formation, while CT or ultrasound surveillance is performed in patient post-EVAR to assess for endoleak formation.

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Abbreviations

18F-FDG:

18F-fluoro-deoxy-glucose

AAA:

Abdominal aortic aneurysm

ACE:

Angiotensin-converting enzyme

ADAM:

Aneurysm Detection and Management

CAD:

Coronary artery disease

CAESAR:

Comparison of surveillance versus aortic endografting for small aneurysm repair

CEUS:

Contrast-enhanced ultrasonography

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

CTA:

Computed tomographic angiography

DREAM:

Dutch Randomized Endovascular Aneurysm Management

DUS:

Duplex ultrasound

EVAR:

Endovascular aneurysm repair

FAST:

Focused Assessment with Sonography in Trauma

HR:

Hazard ratio

IAAA:

Inflammatory abdominal aortic aneurysm

MMP:

Matrix metalloproteinases

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

OR:

Odds ratio

OVER:

Open Versus Endovascular Repair

PAD:

Peripheral artery disease

PET:

Positron emission tomography

PIVOTAL:

Positive Impact of Endovascular Options for treating Aneurysms Early

SPECT:

Single-photon emission computer tomography

UKSAT:

UK Small Aneurysm Trial

US:

Ultrasound

USPSTF:

US Preventative Services Task Force

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Authors and Affiliations

  1. Cardiology, Loyola University Medical Center, Maywood, IL, USA

    Joshua D. Newman & Alexander Turin

  2. Cardiovascular Diseases, Loyola University Medical Center, Maywood, IL, USA

    Afaq Motiwala

  3. Cardiology, University of Nevada, School of Medicine, Las Vegas, NV, USA

    Andrew Chen

  4. Internal Medicine, Loyola University Medical Center, Maywood, IL, USA

    Valmiki Rishi Maharaj

  5. Interventional Cardiology, Vascular and Endovascular Medicine, Loyola University Medical Center, Maywood, IL, USA

    Robert S. Dieter

Authors
  1. Joshua D. Newman
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  2. Afaq Motiwala
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  3. Alexander Turin
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  4. Andrew Chen
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  5. Valmiki Rishi Maharaj
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  6. Robert S. Dieter
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Editor information

Editors and Affiliations

  1. Interventional Cardiology, Vascular and Endovascular Medicine, Loyola University Medical Center, Maywood, IL, USA

    Robert S. Dieter

  2. Cardiovascular and Thoracic Surgery, Northwestern University at Cadence Health Emeritus, Winfield, IL, USA

    Raymond A. Dieter Jr.

  3. University of Tennessee Medical Center, Cardiovascular and Thoracic Surgery, Knoxville, TN, USA

    Raymond A. Dieter III

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Newman, J.D., Motiwala, A., Turin, A., Chen, A., Maharaj, V.R., Dieter, R.S. (2019). Abdominal Aortic Aneurysms. In: Dieter, R., Dieter Jr., R., Dieter III, R. (eds) Diseases of the Aorta . Springer, Cham. https://doi.org/10.1007/978-3-030-11322-3_14

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