on November 6, 2003
Published online before print November 6, 2003, doi: 10.1161/01.ATV.0000106016.13624.4a
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Submitted on July 11, 2003
Accepted on October 8, 2003
Detection, Management, and Prospects for the Medical Treatment of Small Abdominal Aortic Aneurysms
Janet T. Powell * and Anthony R. Brady
From the Department of Vascular Surgery (J.T.P.), Imperial College, London, and University Hospitals, Coventry and Warwickshire, NHS Trust, Coventry, and ICNARC (A.R.B.), London, England.
* To whom correspondence should be addressed. E-mail: janet.powell{at}uhcw.nhs.uk.
Abstract--Small abdominal aortic aneurysms, up to 5.5 cm in diameter, are very common. Ultrasonography is the most cost-effective method of detecting these aneurysms and keeping them under surveillance, because the natural history is 1 of continued expansion. The expansion rate is in the range 0.25 to 0.35 cm/y and is fastest in current smokers. From a study of expansion rates, it has been possible to formulate guidelines for the intervals at which surveillance should occur. Although the evidence from randomized trials indicates that early, open, elective surgery for small aneurysms does not save lives, when aneurysms exceed 5.5 cm in diameter, either open or endovascular surgery is recommended. To prevent small aneurysms reaching the 5.5-cm threshold, new treatments to reduce the expansion rate by >50% need to be designed, based on the underlying pathologic processes: proteolysis and inflammation. Any proposed treatments, including statins, will need to be tested in clinical trials.
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