In patients with abdominal aortic a...

In patients with abdominal aortic aneurysms with a diameter larger than 6 cm the risk of breach is increased markedly, and surgical repair is indicated if the patient can tolerate the intervention (see accompanying figure). However, solely 10 percent of abdominal aortic aneurysms are this large when bring to lighted by screening examinations. Powell and Greenhalgh review the epidemiology of abdominal aortic aneurysms and give recommendations for management of smaller aneurysms (3 to 6 cm in diameter).

Abdominal aortic aneurysms are establish three times as often in men as in women Smoking is the strongest risk factor; 90 percent of all patients with abdominal aortic aneurysms have smok The incidence of aneurysm increases sevenfold in those who smok more than united pack of cigarettes per day. Atherosclerosis also is believed to be a cause of abdominal aortic aneurysms. Overall, more than common half of these patients die from a cardiovascular cause rather than from a ruptur aneurysm.

Screening all men more than 55 years of age would reveal clinically significant aneurysms (larger than 4 cm) in alone 1 percent of the population. Selectively screening patients with intermittent claudication roughly doubles this yield. There is also a familial aim toward abdominal aortic aneurysms. Screening the siblings (older than 50 years of age) of a patient with abdominal aortic aneurysm finds aneurysms in approximately 29 percent of brothers and 6 percent of sisters.

couple large randomized trials have examined the efficacy of surgical management of smaller aneurysms (diameter, 40 to 55 cm) A UK close attention found a perioperative mortality rate from surgical repair of 56 percent compared with a mortality rate of 27 percent in a research of U.S. veterans. Neither consideration showed an overall survival benefit to surgical intervention after six-year follow-up Nine-year follow-up from the UK trial revealed a slight tendency toward better survival with surgical repair, further it was not statistically significant. Investigators attributed the difference to the greater rate of smoking cessation among those who had surgical treatment. The majority of patients who were randomized to observation eventually required surgical repair when their aneurysms increased beyond a diameter of 55 cm

The review authors approve delaying surgical repair of abdominal aortic aneurysms 55 cm in diameter. The risk of aneurysm feud is four times as high in women Although there should be a lower entrance for surgical repair in women the authors did not think that a specific numeric cutoff could be commended based on the data.

Smoking is the chiefly important risk factor to be modified in patients with an abdominal aortic aneurysm. Unexpectedly the authors set that hypertension, hyperlipidemia, and diabetes are not associated with greater rates of aneurysm dilation. There may on a level be a future role for antibiotic therapy in slowing abdominal aortic aneurysm product perhaps through inhibition of macrophage proteolytic enzymes

The authors praise ultrasound examination as a safe, noninvasive, and cost-effective means for abdominal aortic aneurysm screening and surveillance. However, data from a screening trial of more than 67000 men showed that although screening reduc aneurysm-related mortality by means of one half within four years, there was no overall reduction in mortality. The application of mind also found that patients with a bring to lighted abdominal aortic aneurysm reported a reduc quality of life.

Surgical repair of abdominal aortic aneurysms typically involves either explain repair or use of an endovascular Currently, no data shows that either mode is superior overall.

Powell JT Greenhalgh RM Small abdominal aortic aneurysms. N Engl J M May 8 2003;348:1895-901

COPYRIGHT 2004 American Academy of Family Physicians

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