Management of small asymptomatic abdominal aortic aneurysms - a review

Abstract

The approach for abdominal aortic aneurysms (AAAs) larger than 55 mm is well defined due to the risk of rupture being higher than 10% per year, and a 30-day perioperative mortality rate between 2.5% and 5%. However, the approach for small asymptomatic AAAs is less well defined. There are different definitions given to describe a small AAA. The one the authors accepted and applied is "a localized, permanent and irreversible dilation of the aorta of at least 50% in relation to the normal adjacent infrarenal or suprarenal aorta, with a maximum diameter between 30-55 mm". The investigators of the largest study on small AAAs (United Kingdom Small Aneurysm Trial [UK-SAT]) concluded, in brief, that ultrasound monitoring is the most appropriate solution because the results do not support a policy of surgical restoration for AAAs with a diameter of between 40 mm and 55 mm. The aim of the present review article is to highlight several challenges that could change the limits or create a more flexible deciding factor in the management of AAAs. There are multiple factors that influence surgical decision-making, and the limit on aneurysm diameter that indicates surgery should depend on the patient's age, life expectancy, general status, associated diseases, diameter in relation to body mass, risk factors, sex, anxiety and compliance during the follow-up period. Monitoring is an acceptable alternative for AAAs between 40 mm and 55 mm, and is probably the best solution for high-risk patients. Surgery is the most reasonable solution for patients who are at moderate risk, have a significant life expectancy, are less than 70 to 75 years of age, and/or have aortic aneurysms larger than 50 mm.

Clinical Usefulness of Additional Screening for Abdominal Aortic Aneurysm during Transthoracic Echocardiography

“…Until the diameter reaches 40 mm, the rupture risk is very low. 12) In this study only 36 patients (0.63%) had a diameter of AAA greater than 40 mm, which is a clinically meaningful measurement; annual growth rates were not evaluated, which was a limitation of this study. Another significant limitation was that this was a single-center study performed at a tertiary healthcare center; thus, the results of this study cannot be generalized to the Korean population.…”

Profiling of Histone Modifications Reveals Epigenomic Dynamics During Abdominal Aortic Aneurysm Formation in Mouse Models

“…Abdominal aortic aneurysms (AAA) are a relatively common cause of death and are frequently asymptomatic until rupture occurs (1,2). AAA repair is associated with significant morbidity and mortality, particularly when performed emergently; thus far, no medical therapy has proven effective in preventing AAA growth or rupture (3). Human AAA are typically characterized by elastin degradation, loss of vascular smooth muscle cells (VSMCs), and immune cell infiltration (4).…”