Pathophysiology and epidemiology of abdominal aortic aneurysms

医学 无症状的 流行病学 疾病 主动脉瘤 腹主动脉瘤 内科学 外科 生物信息学 动脉瘤 重症监护医学 生物
作者
Ian M. Nordon,Robert J. Hinchliffe,Ian Loftus,Matt Thompson
出处
期刊:Nature Reviews Cardiology [Springer Nature]
卷期号:8 (2): 92-102 被引量:692
标识
DOI:10.1038/nrcardio.2010.180
摘要

Abdominal aortic aneurysms (AAAs) are found in up to 8% of men aged >65 years, yet usually remain asymptomatic until they rupture. Rupture of an AAA and its associated catastrophic physiological insult carries overall mortality in excess of 80%, and 2% of all deaths are AAA-related. Pathologically, AAAs are associated with inflammation, smooth muscle cell apoptosis, and matrix degradation. Once thought to be a consequence of advanced atherosclerosis, accruing evidence indicates that AAAs are a focal representation of a systemic disease of the vasculature. Risk factors for AAAs include increasing age, male sex, smoking, and low HDL-cholesterol levels. Familial associations exist and although susceptibility genes have been described on the basis of candidate-gene studies, robust genetic studies have failed to discover causative gene mutations. The surgical management of AAAs has been revolutionized by minimally invasive endovascular repair. Ongoing randomized trials will establish whether endovascular repair confers a survival advantage over open surgery for patients with a ruptured AAA. In many countries, centralization of vascular surgical services has largely been driven by the improved outcomes of elective aneurysm surgery in specialized centers, the widespread adoption of endovascular techniques, and the introduction of screening programs.
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