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Int J Angiol 2018; 27(02): 058-080
DOI: 10.1055/s-0038-1657771
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Abdominal Aortic Aneurysm: Evolving Controversies and Uncertainties

Davide Carino
1   Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
,
Timur P. Sarac
2   Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Bulat A. Ziganshin
1   Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
3   Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
,
John A. Elefteriades
1   Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations Funding None.
Further Information

Publication History

Publication Date:
29 May 2018 (online)

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Abstract

Abdominal aortic aneurysm (AAA) is defined as a permanent dilatation of the abdominal aorta that exceeds 3 cm. Most AAAs arise in the portion of abdominal aorta distal to the renal arteries and are defined as infrarenal. Most AAAs are totally asymptomatic until catastrophic rupture. The strongest predictor of AAA rupture is the diameter. Surgery is indicated to prevent rupture when the risk of rupture exceeds the risk of surgery. In this review, we aim to analyze this disease comprehensively, starting from an epidemiological perspective, exploring etiology and pathophysiology, and concluding with surgical controversies. We will pursue these goals by addressing eight specific questions regarding AAA: (1) Is the incidence of AAA increasing? (2) Are ultrasound screening programs for AAA effective? (3) What causes AAA: Genes versus environment? (4) Animal models: Are they really relevant? (5) What pathophysiology leads to AAA? (6) Indications for AAA surgery: Are surgeons over-eager to operate? (7) Elective AAA repair: Open or endovascular? (8) Emergency AAA repair: Open or endovascular?

Keywords

abdominal aortic aneurysm - AAA - risk factors - animal models - indication for AAA surgery - rupture AAA - endovascular aortic repair
 

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