Pathogenesis and management of abdominal aortic aneurysm

Abstract

Abdominal aortic aneurysm (AAA) causes ∼170 000 deaths annually worldwide. Most guidelines recommend asymptomatic small AAAs (30 to <50 mm in women; 30 to <55 mm in men) are monitored by imaging and large asymptomatic, symptomatic, and ruptured AAAs are considered for surgical repair. Advances in AAA repair techniques have occurred, but a remaining priority is therapies to limit AAA growth and rupture. This review outlines research on AAA pathogenesis and therapies to limit AAA growth. Genome-wide association studies have identified novel drug targets, e.g. interleukin-6 blockade. Mendelian randomization analyses suggest that treatments to reduce low-density lipoprotein cholesterol such as proprotein convertase subtilisin/kexin type 9 inhibitors and smoking reduction or cessation are also treatment targets. Thirteen placebo-controlled randomized trials have tested whether a range of antibiotics, blood pressure–lowering drugs, a mast cell stabilizer, an anti-platelet drug, or fenofibrate slow AAA growth. None of these trials have shown convincing evidence of drug efficacy and have been limited by small sample sizes, limited drug adherence, poor participant retention, and over-optimistic AAA growth reduction targets. Data from some large observational cohorts suggest that blood pressure reduction, particularly by angiotensin-converting enzyme inhibitors, could limit aneurysm rupture, but this has not been evaluated in randomized trials. Some observational studies suggest metformin may limit AAA growth, and this is currently being tested in randomized trials. In conclusion, no drug therapy has been shown to convincingly limit AAA growth in randomized controlled trials. Further large prospective studies on other targets are needed.

Chemokine Receptor 2 Is A Theranostic Biomarker for Abdominal Aortic Aneurysms

“…Abdominal aortic aneurysms (AAA) represent a potentially life-threatening condition as they typically remain asymptomatic until they subsequently rupture. This unpredictable outcome can lead to a high morbidity and mortality rate, and substantial health care costs (1, 2). AAAs are more prevalent in men, but they rupture more often in women for unknown reasons (3, 4).…”

Shared Genetic Susceptibility between Abdominal Aortic Aneurysm and Cardiometabolic Traits

“…Abdominal aortic aneurysm (AAA), defined as focal dilation of the abdominal aorta by 50% or reaching ≥ 30 mm in diameter, is a complex vascular disease affecting 3-9% population aged over 65 years 1, 2 . It is asymptomatic in early disease stages, with most AAA discovered by incidental imaging or screening protocols.…”

“…Pathologically, AAA is characterized by remodeling and degradation of extracellular matrix, apoptosis of smooth muscle cells, luminal thrombosis, and chronic inflammation 1 . Plaques consisting of lipids, blood cells and other plasma substances accumulate around the lesion sites, with abundant infiltration of innate and adaptive immune cells both in the thrombus and the arterial wall 2 .…”

神经节苷脂gm3的血管保护作用

“…AAA发病隐匿, 目前尚未有效预警策 略. 患者常因破裂腹痛入院, 但瘤体一旦破裂, 死亡率高达 90%以上, 每年在全球范围内导致约170000人死亡 [7] . 针对 AAA的进展, 也缺少有效的药物治疗手段, 而现有的临床手 术介入治疗对有破裂风险的小瘤体AAA进行干预也尚存在 争议 [8] .…”