Advertisement

Abdominal Aortic Aneurysms (Etiology, Epidemiology, and Natural History)

Published:September 27, 2022DOI:https://doi.org/10.1016/j.anclin.2022.08.010

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Anesthesiology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kuivaniemi H.
        • Ryer E.J.
        • Elmore J.R.
        • et al.
        Understanding the pathogenesis of abdominal aortic aneurysms.
        Expert Rev Cardiovasc Ther. 2015; 13: 975-987
        • Livesay J.J.
        • Messner G.N.
        • Vaughn W.K.
        Milestones in the treatment of aortic aneurysm: Denton A. Cooley, MD, and the Texas Heart Institute.
        Tex Heart Inst J. 2005; 32: 130-134
        • Boddy A.M.
        • Lenk G.M.
        • Lillvis J.H.
        • et al.
        Basic research studies to understand aneurysm disease.
        Drug News Perspect. 2008; 21: 142-148
        • Azarbal A.F.
        • Repella T.
        • Carlson E.
        • et al.
        A Novel Model of Tobacco Smoke-Mediated Aortic Injury.
        Vasc Endovascular Surg. 2022; 56 (Epub 2021 Dec 27. PMID: 34961389): 244-252https://doi.org/10.1177/15385744211063054
        • Hinterseher I.
        • Gäbel G.
        • Corvinus F.
        • et al.
        Presence of Borrelia burgdorferi sensu lato antibodies in the serum of patients with abdominal aortic aneurysms.
        Eur J Clin Microbiol Infect Dis. 2012; 31: 781-789
        • Filipovic M.
        • Goldacre M.J.
        • Roberts S.E.
        • et al.
        Trends in mortality and hospital admissions for abdominal aortic aneurysm in England and Wales, 1979-1999.
        Br J Surg. 2005; 92: 968-975
        • Gillum R.F.
        epidemiology of aortic aneurysm in the United States.
        J Clin Epidemiol. 1995; 48: 1289-1298
        • Svensjö S.
        • Björck M.
        • Gürtelschmid M.
        • et al.
        Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease.
        Circulation. 2011; 124: 1118-1123
        • Oliver-Williams C.
        • Sweeting M.J.
        • Turton G.
        • et al.
        Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme.
        Br J Surg. 2018; 105: 68-74
        • Kent K.C.
        • Zwolak R.M.
        • Egorova N.N.
        • et al.
        Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals.
        J Vasc Surg. 2010; 52: 539-548
        • Summers K.L.
        • Kerut E.K.
        • Sheahan C.M.
        • et al.
        Evaluating the prevalence of abdominal aortic aneurysms in the United States through a national screening database.
        J Vasc Surg. 2021; 73: 61-68
        • Forsdahl S.H.
        • Singh K.
        • Solberg S.
        • et al.
        Risk factors for abdominal aortic aneurysms: A 7-year prospective study: The Tromsø study, 1994-2001.
        Circulation. 2009; 119: 2202-2208
        • Howard D.P.J.
        • Banerjee A.
        • Fairhead J.F.
        • et al.
        Population-based study of incidence of acute abdominal aortic aneurysms with projected impact of screening strategy.
        J Am Heart Assocaiton. 2015; 4e001926
      1. Final Recommendation Statement: Abdominal Aortic Aneurysm: Screening. Uspreventiveservicestaskforce.org. Published December 10, 2019. Accessed December 22, 2021. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening#citation35

        • Thompson S.G.
        • Ashton H.A.
        • Gao L.
        • et al.
        Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomized Multicentre Aneurysm Screening Study.
        BMJ. 2009; 338: b2307
        • Mohansson M.
        • Hansson A.
        • Brodersen J.
        Estimating overdiagnosis in screening for abdominal aortic aneurysm: Could a change in smoking habits and lowered aortic diameter tip the balance of screening towards harm?.
        BMJ. 2015; 350: h825
        • Ashton H.A.
        • Buxton M.J.
        • Day N.E.
        • et al.
        The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: A randomised controlled trial.
        Lancet. 2002; 260: 1531-1539
        • Stuntz M.
        • Audibert C.
        • Su Z.
        Persisting disparities between sexes in outcomes of ruptured abdominal aortic aneurysm hospitalizations.
        Nat Scientific Rep. 2017; 7: 17994
        • Kühnl A.
        • Erik A.
        • Trenner M.
        • et al.
        Incidence, treatment and mortality in patients with abdominal aortic aneurysms: An analysis of hospital discharge data from 2005-2014.
        Deutsches Ärzteblatt Int. 2017; 114: 391-398
        • Sciria C.T.
        • Osorio B.
        • Wang J.
        • et al.
        Sex-based disparities in outcomes with abdominal aortic aneurysms.
        Am J Cardiol. 2021; 155: 135-148
        • Aune D.
        • Schlesinger S.
        • Norat T.
        • et al.
        Tobacco smoking and the risk of abdominal aortic aneurysm: A systematic review and meta-analysis of prospective studies.
        Scientific Rep. 2018; 814786
        • Mulorz J.
        • Mulorz P.
        • Wagenhaeuser M.U.
        • et al.
        E-cigarette vapor accelerates abdominal aortic aneurysm in mice [446].
        Arterioscler Thromb Vasc Biol. 2019; 39 (Available at:): A446
        • Clayton S.
        • DeVallance E.
        • Branyan K.
        • et al.
        Vaping to vascular damage: The role of e-cigarettes on vascular function.
        FASEB J. 2018; 31: lb651
        • MacSweeney S.T.
        • Ellis M.
        • Worrell P.C.
        • et al.
        Smoking and growth rate of small abdominal aortic aneurysms.
        Lancet. 1994; 344: 651-652
        • Blanchard J.F.
        • Armenian H.K.
        • Friesen P.P.
        Risk factors for abdominal aortic aneurysm: Results of a case-control study.
        Am J Epidemiol. 2000; 151: 575-583
        • Li S.R.
        • Rietz K.M.
        • Gabriel L.
        The epidemiology of race- and sex-specific hospitalizations for abdominal aortic aneurysms [10519].
        Circulation. 2021; 144 (Available at:)
        • Linné A.
        • Lindström D.
        • Hultgren R.
        High prevalence of abdominal aortic aneurysms in brothers and sisters of patients despite a low prevalence in the population.
        J Vasc Surg. 2012; 56: 305-310
        • Deery S.E.
        • O’Donnell T.F.X.
        • Shean K.E.
        • et al.
        Racial disparities in outcomes after intact abdominal aortic aneurysm repair.
        J Vasc Surg. 2018; 67: 1059-1067
        • Marcaccio C.
        • de Guerre L.
        • Patel P.
        • et al.
        Racial and ethnic differences in long-term outcomes after elective endovascular repair of abdominal aortic aneurysm.
        J Vasc Surg. 2021; 74: 160-161https://doi.org/10.1016/j.jvs.2021.06.244
        • Joergensen T.M.M.
        • Christensen K.
        • Lindholt J.S.
        • et al.
        Editor’s choice - high heritability of liability to abdominal aortic aneurysms: A population based twin study.
        Eur J Vasc Endovascular Surg. 2016; 52: 41-46
        • Pinard A.
        • Jones G.T.
        • Milewicz D.M.
        Genetics of thoracic and abdominal aortic diseases.
        Circ Res. 2019; 124: 588-606
        • Singh T.P.
        • Field M.A.
        • Bown M.J.
        • et al.
        Systematic review of genome-wide association studies of abdominal aortic aneurysm.
        Atherosclerosis. 2021; 327: 39-48https://doi.org/10.1016/j.atherosclerosis.2021.05.001
        • Takagi H.
        • Umemoto T.
        Coronary. Coronary artery disease and abdominal aortic aneurysm growth.
        Vasc Med. 2016; 21: 199-208
        • van de Luijtgaarden K.M.
        • Gonçalves F.B.
        • Hoeks S.E.
        • et al.
        Lower atherosclerotic burden in familial abdominal aortic aneurysm.
        J Vasc Surg. 2014; 59: 589-593
        • Aune D.
        • Schlesinger S.
        • Norat T.
        • et al.
        Diabetes mellitus and the risk of abdominal aortic aneurysm: A systematic review and meta-analysis of prospective studies.
        J Diabetes Its Complications. 2018; 32: 1169-1174
        • Yuan Z.
        • Heng Z.
        • Lu Y.
        • et al.
        The protective effect of metformin on abdominal aortic aneurysm: A systematic review and meta-analysis.
        Front Endocrinol. 2021; 12: 721213
        • Kaluza J.
        • Stackelberg O.
        • Harris H.R.
        • et al.
        Anti-inflammatory diet and risk of abdominal aortic aneurysm in two Swedish cohorts.
        Heart. 2019; 105: 1876-1883
        • Aune D.
        • Sen A.
        • Kobeissi E.
        • et al.
        Physical activity and the risk of abdominal aortic aneurysm: A systemic review and meta-analysis of prospective studies.
        Nat Scientific Rep. 2020; 10: 22287
        • Kokje V.B.C.
        • Hamming J.F.
        • Lindeman J.H.N.
        Editor’s choice – pharmaceutical management of small abdominal aortic aneurysms: A systematic review of the clinical experience.
        Eur J Vasc Endovascular Surg. 2015; 50: 702-713
        • Golledge J.
        • Moxon J.V.
        • Singh T.P.
        • et al.
        Lack of an effective drug therapy for abdominal aortic aneurysm.
        J Intern Med. 2020; 288: 6-22
        • Meijer C.A.
        • Stijnen T.
        • Wasser M.N.
        • et al.
        Doxycycline for stabilization of abdominal aortic aneurysms: a randomized trial.
        Ann Intern Med. 2013; 159: 815-823
        • Sweeting M.J.
        • Thompson S.G.
        • Brown L.C.
        • et al.
        Use of angiotensin converting enzyme inhibitors is associated with increased growth rate of abdominal aortic aneurysms.
        J Vasc Surg. 2010; 52: 1-4
        • Karrowni W.
        • Dughman S.
        • Hajj G.P.
        • et al.
        Statin therapy reduces growth of abdominal aortic aneurysms.
        J Investig Med. 2011; 59: 1239-1243
        • Thanigaimani S.
        • Singh T.P.
        • Unosson J.
        • et al.
        Editor’s choice – Association between metformin prescription and abdominal aortic aneurysm growth and clinical events: A systematic review and meta-analysis.
        Eur J Vasc Endovascular Surg. 2021; 62: 747-756
      2. Metformin Therapy in Non-diabetic AAA Patients (MetAAA). Clinicaltrials.gov. Published April 25, 2018. Updated October 24, 2019.
        (Available at:) (Accessed January 27, 2022)
      3. Limiting AAA With Metformin (LIMIT) Trial (LIMIT). Clinicaltrials.gov Published Au’gust 5, 2020. Updated September 8, 2021.
        (Available at:) (Accessed January 27, 2022)
      4. Metformin for Abdominal Aortic Aneurysm Growth Inhibition (MAAAGI). Clinicaltrials.gov. Published January 13, 2020. Updated September 30, 2021.
        (Available at:) (Accessed January 27, 2022)
        • Moxon J.V.
        • Parr A.
        • Emeto T.I.
        • et al.
        Diagnosis and monitoring of abdominal aortic aneurysm: Current status and future prospects.
        Curr Probl Cardiol. 2011; 35: 512-548
        • Speelman L.
        • Hellenthal F.A.
        • Pulinx B.
        • et al.
        The influence of wall stress on AAA growth and biomarkers.
        Eur J Vasc Endovascular Surg. 2010; 39: 410-416
        • Thompson S.G.
        • Bown M.J.
        • Sweeting M.J.
        • et al.
        Surveillance intervals for small abdominal aortic aneurysms: A meta-analysis.
        JAMA. 2013; 309: 806-813
        • Parkinson F.
        • Ferguson S.
        • Lewis P.
        • et al.
        Rupture rates of untreated large abdominal aortic aneurysms in patients unfit for elective repair.
        J Vasc Surg. 2015; 61: 1606-1612
        • Akai A.
        • Watanabe Y.
        • Hoshina K.
        • et al.
        Family history of aortic aneurysm is an independent risk factor for more rapid growth of small abdominal aortic aneurysms in Japan.
        J Vasc Surg. 2015; 61: 287-290
        • Hall A.J.
        • Busse E.F.
        • McCarville D.J.
        • et al.
        Aortic wall tension as a predictive factor for abdominal aortic aneurysm rupture: Improving the selection of patients for abdominal aortic aneurysm repair.
        Ann Vasc Surg. 2000; 14: 152-157
        • Doye B.J.
        • Bappoo N.
        • Syed M.B.J.
        • et al.
        Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.
        Eur J Vasc Endovascular Surg. 2020; 60: 365-373
        • Fillinger M.F.
        • Marra S.P.
        • Raghavan M.L.
        • et al.
        Prediction of rupture risk in abdominal aortic aneurysm during observation: Wall stress versus diameter.
        J Vasc Surg. 2003; 37: 724-732
        • Soden P.A.
        • Zettervall S.L.
        • Ultee K.H.J.
        • et al.
        Outcomes for symptomatic abdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).
        J Vasc Surg. 2016; 64: 297-305
        • Chaikoff E.L.
        • Dalman R.L.
        • Eskandari M.K.
        • et al.
        The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.
        J Vasc Surg. 2018; 67: 2-77
        • Wilberger Jr., J.E.
        Lumbosacral radiculopathy secondary to abdominal aortic aneurysms: Report of three cases.
        J Neurosurg. 1983; 58: 965-967
        • El-Kayali A.
        • Al-Salman M.M.S.
        Unusual presentation of acute bilateral lower limb ischemia (thrombosis of abnormal aortic aneurysm).
        Ann Saudi Med. 2001; 21
        • Li H.
        • Chan Y.C.
        • Cui D.
        • et al.
        Acute thrombosis of an infrarenal abdominal aortic aneurysm presenting as bilateral critical lower limb ischemia.
        Vasc Endovascular Surg. 2020; 55: 186-188
        • Kumar Y.
        • Hooda K.
        • Li S.
        • et al.
        Abdominal aortic aneurysm: Pictorial review of common appearances and complications.
        Ann Translation Med. 2017; 5: 256
        • Fink H.A.
        • Lederle F.A.
        • Roth C.S.
        • et al.
        The accuracy of physical examination to detect abdominal aortic aneurysm.
        Arch Intern Med. 2000; 160: 833-836
        • Lederle F.A.
        • Walker J.M.
        • Reinke D.B.
        Selective screening for abdominal aortic aneurysms with physical examination and ultrasound.
        Arch Intern Med. 1988; 148 (Available at:): 1753-1756
        • Wadgaonkar A.D.
        • Black 3rd, J.H.
        • Weihe E.K.
        • et al.
        Abdominal aortic aneurysms revisted: MDCT with multiplanar reconstructions for identifying indicators of instability in the pre- and postoperative patient.
        Radiographics. 2015; 35: 254-268
        • Fadel B.M.
        • Mohty D.
        • Kazzi B.E.
        • et al.
        Ultrasound Imaging of the Abdominal Aorta: A Comprehensive Review.
        J Am Soc Echocardiogr. 2021; 34: 1119-1136
        • van Walraven C.
        • Wong J.
        • Morant K.
        • et al.
        Incidence, follow-up, and outcomes of incidental abdominal aortic aneurysms.
        J Vasc Surg. 2010; 52: 282-289
        • Jalalzadeh H.
        • Indrakusuma R.
        • Planken R.N.
        • et al.
        Inflammation as a predictor of abdominal aortic aneurysm growth and rupture: A systematic review of imaging biomarkers.
        Eur J Vasc Endovascular Surg. 2016; 52: 333-342
        • Lareyre F.
        • Chaudhuri A.
        • Flory V.
        • et al.
        Automatic measurement of maximal diameter of abdominal aortic aneurysm on computed tomography angiography using artificial intelligence [published online ahead of print, 2021 Dec 22].
        Ann Vasc Surg. 2021; S0890-5096: 00963-00968
        • Reimerink J.J.
        • van der Laan M.J.
        • Koelemay M.J.
        • et al.
        Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm.
        Br J Surg. 2013; 100: 1405-1413
        • Abdulameer H.
        • Taii H.A.
        • Al-Kindi S.G.
        • et al.
        Epidemiology of fatal ruptured aortic aneurysms in the United States (1999-2016).
        J Vasc Surg. 2019; 69: 278-384
        • Akkersdijk G.J.M.
        • van Bockel J.H.
        Ruptured abdominal aortic aneurysm: Initial misdiagnosis and the effect on treatment.
        Eur J Surg. 1998; 164: 29-34
        • Banerjee A.
        Atypical manifestations of ruptured abdominal aortic aneurysms.
        Postgrad Med J. 1993; 69: 6-11
        • Metcalfe D.
        • Sugand K.
        • Thrumurthy S.G.
        • et al.
        Diagnosis of ruptured abdominal aortic aneurysm: A multicentre cohort study.
        Eur J Emerg Med. 2016; 23: 386-390
        • Vu K.
        • Kaitoukov Y.
        • Morin-Roy F.
        • et al.
        Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms.
        Insights into Imaging. 2014; 5: 281-293
        • Cao P.
        • De Rango P.
        • Verzini F.
        • et al.
        Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): Results from a randomised trial.
        Eur J Vasc Endovascular Surg. 2011; 41: 13-25
        • Lederle F.A.
        • Johnson G.R.
        • Wilson S.E.
        • et al.
        Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair.
        JAMA. 2002; 287: 2968-2972
        • Kontopodis N.
        • Pantidis D.
        • Dedes A.
        • et al.
        The – not so – solid 5.5 cm threshold for abdominal aortic aneurysm repair: Facts, misinterpretations, and future directions.
        Front Surg. 2016; 3: 1-6
        • Suckow B.D.
        • Goodney P.P.
        • Columbo J.A.
        • et al.
        National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
        J Vasc Surg. 2017; 67: 1690-1697
        • Lederle F.A.
        • Kyriakides T.C.
        • Stroupe K.T.
        • et al.
        Open versus endovascular repair of abdominal aortic aneurysm.
        New Year J Med. 2019; 380: 2126-2135
        • Lieberg J.
        • Kadatski K.G.
        • Kals M.
        • et al.
        Five-year survival after elective open and endovascular aortic aneurysm repair.
        Scand J Surg. 2021; 0: 1-7
        • Li B.
        • Khan S.
        • Salata K.
        • et al.
        A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm.
        J Vasc Surg. 2019; 70: 954-969