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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:2605.)
© 2006 American Heart Association, Inc.

Brief Reviews

Abdominal Aortic Aneurysm

Pathogenesis and Implications for Management

Jonathan Golledge; Juanita Muller; Alan Daugherty; Paul Norman

From the Vascular Biology Unit (J.G., J.M.), School of Medicine, James Cook University, Townsville, Australia; Cardiovascular Research Center (A.D.), Gill Heart Institute, University of Kentucky, Lexington; and the School of Surgery and Pathology (P.N.), University of Western Australia, Fremantle Hospital, Fremantle, Western Australia.

Correspondence to Professor Jonathan Golledge, Director, The Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Queensland 4811, Australia. E-mail Jonathan.Golledge{at}jcu.edu.au

Series Editor: Robert W. Thompson
Abdominal Aortic Aneurysms: Pathophysiological Mechanisms and Clinical Implications
ATVB In Focus

Previous Brief Reviews in this Series:

•Powell JT, Brady AR. Detection, management, and prospects for the medical treatment of small abdominal aortic aneurysms. 2004;24:241–245.
•Daugherty A, Cassis LA. Mouse models of abdominal aortic aneurysms. 2004;24:429–434.
•Pasterkamp G, Galis ZS, de Kleijn DPV. Expansive arterial remodeling: location, location, location. 2004;24:650–657.
•Shimizu K, Mitchell RN, Libby P. Inflammation and cellular immune responses in abdominal aortic aneurysms. 2006;26:987–994.

Abdominal aortic aneurysm (AAA) affects approximately 5% of elderly men and is responsible for a significant number of deaths in Western Countries. At present surgery by open or endovascular means is the only widely used therapy for this condition. In this review we examine the risk factors, serum, and genetic associations of AAA. Epidemiology studies suggest that smoking cessation and control of cholesterol and blood pressure should reduce the number of patients developing AAA. Natural history studies suggest that smoking cessation should reduce the rate of progression of AAA. Clear level 1 evidence for drug treatments of AAA are presently lacking; however, animal and human in vitro studies suggest that medication targeted at reducing inflammation and proteolysis are most likely to be beneficial, with limited data to support the use of statins, Angiotensin II inhibitors, and macrolides. Work has commenced in understanding which patients, identified by clinical, serum, and genotype, are more at risk of AAA progression and thus should be selected out for aggressive treatment. Well designed large multicenter randomized controlled trials are required to examine the medical treatment of AAA.

Abdominal aortic aneurysm is associated with significant morbidity and mortality. Presently medical therapy for this condition has been neglected. This article summarises efforts to better understand the pathology of AAA to develop such treatments.

Key Words: abdominal aortic aneurysm • pathogenesis • medication

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