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Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:241-245
Published online before print November 6, 2003, doi: 10.1161/01.ATV.0000106016.13624.4a
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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:241.)
© 2004 American Heart Association, Inc.

Brief Reviews

Detection, Management, and Prospects for the Medical Treatment of Small Abdominal Aortic Aneurysms

Janet T. Powell; 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.

Correspondence to Prof J.T. Powell, Medical Director, University Hospitals, Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK. E-mail janet.powell{at}uhcw.nhs.uk

Series Editor:: Robert W. Thompson
ATVB In Focus

Abdominal Aortic Aneurysms: Pathophysiological Mechanisms and Clinical Implications

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.


Key Words: aneurysms • aorta • smoking • ultrasonography




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