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Encyclopedia > Abdominal aortic aneurysm
Abdominal aortic aneurysm
Classification and external resources
ICD-10 I71.3, I71.4
ICD-9 441.3, 441.4
OMIM 100070
DiseasesDB 792
MedlinePlus 000162
eMedicine med/3443  emerg/27 radio/1
MeSH D017544
A plate from Gray's Anatomy with yellow lines depicting the most common infrarenal location of the AAA.
A plate from Gray's Anatomy with yellow lines depicting the most common infrarenal location of the AAA.

Abdominal aortic aneurysm, also written as AAA and often pronounced 'triple-A', is a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%. The normal diameter of the infrarenal aorta is 2 cm. It is caused by a degenerative process of the aortic wall, however the exact etiology remains unknown. It is most commonly located below the kidneys (infrarenally; 90%), other possible locations are above or at the level of the kidneys (suprarenal and pararenal). The aneurysm can extend to include one or both of the iliac arteries. An aortic aneurysm may also occur in the thorax. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Image File history File links No higher resolution available. ... An illustration from the 1918 edition Henry Grays Anatomy of the Human Body (or Grays Anatomy as it has more commonly become known) is an anatomy textbook widely regarded as a classic work on human anatomy. ... AORTA can also mean always-on real-time access, referring to WAN computer networks. ... The word degeneracy has more than one meaning: In general, degeneracy means reverting to an earlier, simpler, state The term moral degeneracy is sometimes used by speakers commenting on the morality (or lack thereof) of a society: this usage has its roots in the concept of atavism. ... In human anatomy, iliac artery refers to several anatomical structures located in the pelvis: Common iliac artery - forms at terminus of the aorta. ... An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ... Diagram of a tsetse fly, showing the head, thorax and abdomen The thorax is a division of an animals body that lies between the head and the abdomen. ...


An abdominal aortic aneurysm occurs most commonly in older individuals (between 65 and 75), and more in men and smokers. There is moderate evidence to support screening in individuals with these risk factors. The majority of abdominal aortic aneurysms do not cause symptoms. Symptomatic and large aneurysms (>5 cm in diameter) are considered for repair. Old age consists of ages nearing the average lifespan of human beings, and thus the end of the human life cycle. ... Screening, in general, is the investigation of a great number of something (for instance, people) looking for those with a particular problem or feature. ... The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom can be a physical condition which shows that one has a particular illness or disorder (see e. ...


The most important complication of an abdominal aortic aneurysm is rupture, which is most often a fatal event. An abdominal aortic aneurysm weakens the walls of the blood vessel, leaving it vulnerable to bursting open, or rupturing, and spilling large amounts of blood into the abdominal cavity.[1]

Contents

History

The first historical records about AAA are from Ancient Rome, more precisely from the 2nd century AD, when Greek surgeon Antyllus tried to treat the AAA with proximal and distal ligature, central incision and evacuation of thrombotic material from the aneurysm. However, attempts to treat the AAA surgically were unsuccessful until 1923. In that year, Rudolph Matas (who also proposed the concept of endoaneurysmorrhaphy), performed the first successful aortic ligation on a human.[2] Other methods that were successful in treating the AAA included wrapping the aorta with polyethene cellophane, which induced fibrosis and restricted the growth of the aneurysm. Albert Einstein was operated on by Rudolf Nissen with use of this technique in 1949, and survived five years after the operation.[3] Ancient Rome was a civilization that grew from a small agricultural community founded on the Italian Peninsula circa the 9th century BC to a massive empire straddling the Mediterranean Sea. ... The 2nd century is the period from 101 - 200 in accordance with the Julian calendar in the Christian Era. ... Antyllus was a Greek surgeon, who lived in the 2nd century AD in Rome. ... In zootomy, several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... In zootomy, several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... Post surgical photo of brain aneurysm survivor. ... Year 1923 (MCMXXIII) was a common year starting on Monday (link will display the full calendar) of the Gregorian calendar. ... Rudolph Matas, M.D., (1860-1957), born in Bonne Carre, Louisiana, was a prominent and innovative surgeon. ... Cellophane is a thin, transparent sheet made of processed cellulose. ... Fibrosis is the formation or development of excess fibrous connective tissue in an organ or tissue as a reparative or reactive process, as opposed to a formation of fibrous tissue as a normal constituent of an organ or tissue. ... “Einstein” redirects here. ... This article does not cite any references or sources. ...


Epidemiology

AAA is uncommon in individuals of African, Asian, and Hispanic heritage. The frequency varies strongly between males and females. The peak incidence is among males around 70 years of age, the prevalence among males over 60 years totals 2-6%. The frequency is much higher in smokers than in non-smokers (8:1), and the risk decreases slowly after smoking cessation.[4] Other risk factors include hypertension and male sex.[5] In the U.S., the incidence of AAA is 2-4% in the adult population. [6]. AAA is 4-6 times more common in male siblings of known patients, with a risk of 20-30%.[7] Incidence is a measure of the risk of developing some new condition within a specified period of time. ... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ... For other forms of hypertension, see Hypertension (disambiguation). ...


Rupture of the AAA occurs in 1-3% of men aged 65 or more, the mortality is 70-95%.[8]


Etiology

The exact causes of the degenerative process remain unclear. There are, however, some theories and risk factors defined. A risk factor is a concept in finance theory such as the CAPM, APT and other theories that use pricing kernels. ...

  • Genetic influences: The influence of genetic factors is highly probable. The high familial prevalence rate is most notable in male individuals.[9] There are many theories about the exact genetic disorder that could cause higher incidence of AAA among male members of the affected families. Some presumed that the influence of alpha 1-antitrypsin deficiency could be crucial, some experimental works favored the theory of X-linked mutation, which would explain the lower incidence in heterozygous females. Other theories of genetic etiology were also formulated.[6]
  • Hemodynamic influences: Abdominal aortic aneurysm is a focal degenerative process with predilection for the subrenal aorta. The histological structure and mechanical characteristics of subrenal aorta differ from those of the thoracic aorta. The diameter decreases from the root to the bifurcation, and the wall of the abdominal aorta also contains a lesser proportion of elastin. The mechanical tension in abdominal aortic wall is therefore higher than in the thoracic aortic wall. The elasticity and distensibility also decline with age, which can result in gradual dilatation of the segment. Higher intraluminal pressure in patients with arterial hypertension markedly contributes to the progression of the pathological process.[5]
  • Atherosclerosis: The AAA was long considered to be caused by atherosclerosis, because the walls of the AAA are frequently affected heavily. However, this theory cannot be used to explain the initial defect and the development of occlusion, which is observed in the process.[6]

RNA expression pattern Orthologs Human Mouse Entrez Ensembl Uniprot Refseq Location Pubmed search alpha 1-Antitrypsin or α1-antitrypsin (A1AT) is a glycoprotein and generally known as serum trypsin inhibitor. ... Sex-linked genes are those carried on the mammalian X chromosome but not the Y chromosome. ... For linguistic mutation, see Apophony. ... Heterozygote cells are diploid or polyploid and have different alleles at a locus (position) on homologous chromosomes. ... The largest artery in the human body, the aorta originates from the left ventricle of the heart and brings oxygenated blood to all parts of the body in the systemic circulation. ... Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. ... Tension may mean: In physics, tension is a force related to the stretching of a string or a similar object. ... Elasticity is a branch of physics which studies the properties of elastic materials. ... An infection is the detrimental colonization of a host organism by a foreign species. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Arteritis is inflammation of the walls of arteries, usually as a result of infection or auto-immune response. ... Cystic medial necrosis (also referred to as cystic medial degeneration) is a disorder of large arteries, in particular the aorta, where there is a focal degeneration of the elastic tissue and the muscle in the tunica media (the middle layer of the artery), with the presence of mucoid material in... Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue. ... Marfan syndrome is an autosomal dominant genetic disorder of the connective tissue characterized by disproportionately long limbs, long thin fingers, a typically tall stature, and a predisposition to cardiovascular abnormalities, specifically those affecting the heart valves and aorta. ... Ehlers-Danlos syndrome is a group of rare genetic disorders affecting humans and domestic animals caused by a defect in collagen synthesis. ...

Pathophysiology

The most striking histopathological changes of aneurysmatic aorta are seen in tunica media and intima. These include accumulation of lipids in foam cells, extracellular free cholesterol crystals, calcifications, ulcerations and ruptures of the layers and thrombosis. There is an adventitial inflammatory infiltrate.[5] However, the degradation of tunica media by means of proteolytic process seems to be the basic pathophysiologic mechanism of the AAA development. Some researchers report increased expression and activity of matrix metalloproteinases in individuals with AAA. This leads to elimination of elastine from the media, rendering the aortic wall more susceptible to the influence of the blood pressure. [6] Other pathophysiological cause for development of the AAA is inflammation. The tunica media (or just media) is the middle layer of an artery. ... This page meets Wikipedias criteria for speedy deletion. ... Foam cells are cells in an atheroma derived from both macrophages and smooth muscle cells which have accumulated low density lipoproteins,LDLs, by endocytosis. ... Cholesterol is a sterol (a combination steroid and alcohol). ... Dystrophic calcification is the mineralization of soft tissue without a systemic mineral imbalance. ... Look up degradation in Wiktionary, the free dictionary. ... A sphygmomanometer, a device used for measuring arterial pressure. ...


Screening

A clinical practice guideline by the U.S. Preventive Services Task Force "recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men age 65 to 75 years who have ever smoked".[10][11] This is a grade B recommendation[12]. A re-analysis of the meta-analysis estimated a number needed to screen of approximately 850 patients.[13] Clinical practice guidelines are collections of practical information for use by doctors and other medical professionals. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ...


The largest of the randomized controlled trials on which this guideline was based studied a screening program that consisted of[14]: A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

Screening men ages 65-74 years (not restricted to ever smokers). 'Men in whom abdominal aortic aneurysms (> or =3 cm in diameter) were detected were followed-up... Patients with an aortic diameter of 3·0–4·4 cm were rescanned at yearly intervals, whereas those with an aortic diameter of 4·5–5·4 cm were rescanned at 3-monthly intervals ... Surgery was considered on specific criteria (diameter > or =5.5 cm, expansion > or =1 cm per year, symptoms)'.

This trial reported significant short[14] ( number needed to screen after 4 years of approximately 590 to prevent nonfatal ruptured AAA plus AAA-related deaths[15]) and long term[16] ( number needed to screen after 7 years of approximately 280 to prevent nonfatal ruptured AAA plus AAA-related deaths) benefit and cost effectiveness.[17] Subsequent randomized controlled trials also found benefit: The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

In the U.S., effective January 1, 2007, provisions of the SAAAVE Act (Screening Abdominal Aortic Aneurysm Very Efficiently) now provide a free, one-time, ultrasound AAA screening benefit for those qualified seniors. Men who have smoked at least 100 cigarettes during their life, and men and women with a family history of AAA qualify for the one-time ultrasound screening. Enrollees must visit their healthcare professional for their Welcome to Medicare physical within six months of enrolment in order to qualify for the free screening. The Welcome to Medicare Physical Exam must be completed within the first six months of Medicare eligibility, but there is no published time limit thereafter for completion of the AAA screening. Providers who perform the physical and order the AAA screening need to document the AAA risk factors.[20] The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ...


Manifestations and Diagnosis

AAAs are commonly divided according to their size and symptomatology. An aneurysm is usually considered to be present if the measured outer aortic diameter is over 3 cm (normal diameter of aorta is around 2 cm). The natural history is of increasing diameter over time, followed eventually by the development of symptoms (usually rupture). If the outer diameter exceeds 5 cm, the aneurysm is considered to be large. For aneurysms under 5 cm, the risk of rupture is low, so that the risks of surgery usually outweigh the risk of rupture. Aneurysms less than 5cm are therefore usually kept under surveillance until such time as they become large enough to warrant repair, or develop symptoms.[5][8] The vast majority of aneurysms are asymptomatic. The risk of rupture is high in a symptomatic aneurysm, which is therefore considered an indication for surgery. Possible symptoms include low back pain, flank pain, abdominal pain, groin pain or pulsating abdominal mass.[21] The complications include rupture, peripheral embolisation, acute aortic occlusion, aortocaval or aortoduodenal fistulae. On physical examination, a palpable abdominal mass can be noted. Bruits can be present in case of renal or visceral arterial stenosis.[6] The aorta (generally pronounced [eɪˈɔːtə] or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ... In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... In medicine, a fistula (pl. ...

CT image showing an abdominal aortic aneurysm.
CT image showing an abdominal aortic aneurysm.

As most of the AAAs are asymptomatic, their presence is usually revealed during an abdominal examination for another reason - the most common being abdominal ultrasonography. A physician may also detect the presence of an AAA by abdominal palpation. Ultrasonography provides the initial assessment of the size and extent of the aneurysm, and is the usual modality for surveillance. Preoperative examinations include CT, MRI and special modes thereof, like CT/MR angiography. Angiography may be useful also, as an additional method of measurement for the planning of endoluminal repair. Note that an aneurysmal aorta may appear normal on angiogram, due to thrombus within the sac. negron305 Cat scan redirects here. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ...


Rupture

The clinical manifestation of ruptured AAA can include low back, flank, abdominal or groin pain, but the bleeding usually leads to a hypovolemic shock with hypotension, tachycardia, cyanosis, and altered mental status. The mortality of AAA rupture is up to 90%. 65-75% of patients die before they arrive at hospital and up to 90% die before they reach the operating room.[22] The bleeding can be retroperitoneal or intraperitoneal, or the rupture can create an aortocaval or aortointestinal fistula.[5]. Flank ecchymosis is a sign of retroperitoneal hemorrhage, and is also called the Grey-Turner sign.[6] Ruptured AAA is a clinical diagnosis: the presence of the triad of abdominal pain, shock and pulsatile abdominal mass makes the diagnosis; no further investigations are required for diagnostic purposes, and imaging should not delay surgery. The operative mortality has slowly decreased over several decades but remains higher than 40%.[23] In physiology and medicine, hypovolemia is a state of decreased blood volume. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... This article or section does not cite any references or sources. ... Cyanosis refers to the bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. ...


Treatment

The treatment options for asymptomatic AAA are immediate repair, surveillance with a view to eventual repair, and conservative management. There are currently two modes of repair available for an AAA: open aneurysm repair (OR), and endovascular aneurysm repair (EVAR). Endovascular Aneurysm or Aortic Repair, is a type of Endovascular surgery used to treat an Abdominal aortic aneurysm or AAA. // Example of a Stent used in an EVAR Before patients are deemed to be a suitable candidate for this treatment, they have to go through a rigorous set of tests. ...

  • Conservative treatment is indicated in patients where repair carries a high risk of mortality and also in patients where repair is unlikely to improve life expectancy. The two mainstays of the conservative treatment are smoking cessation and blood pressure control. Recent studies have suggested possible protective effects of therapy with angiotensin converting enzyme inhibitors or statins.[24][25]
  • Surveillance is indicated in small aneurysms, where the risk of repair exceeds the risk of rupture. As an AAA grows in diameter the risk of rupture increases. Surveillance until the aneurysm has reached a diameter of 5cm has not been shown to have a higher risk as compared to early intervention.[26][27] The threshold for repair varies slightly from individual to individual, depending on the balance of risks and benefits when considering repair versus ongoing surveillance. The size of an individual's native aorta may influence this, along with the presence of comorbitities that increase operative risk or decrease life expectancy.
  • Open repair (operation) is indicated in young patients as an elective procedure, or in growing or large, symptomatic or ruptured aneurysms. Open repair has been the mainstay of intervention from the 1950's until recently.
  • Endovascular repair first became practical in the 1990's and although it is now an established alternative to open repair, its role is yet to be clearly defined. It is generally indicated in older, high-risk patients or patients unfit for open repair. However, endovascular repair is feasible for only a proportion of AAA's, depending on the morphology of the aneurysm. The main advantage over open repair is that there is less peri-operative mortality, less time in intensive care, less time in hospital overall and earlier return to normal activity. Disadvantages of endovascular repair include a requirement for more frequent ongoing hospital reviews, and a higher chance of further procedures being required. According to the latest studies, the EVAR procedure doesn't offer any benefit for overall survival or health-related quality of life compared to open surgery, although aneurysm-related mortality is lower.[28][29][30][31] In patients unfit for open repair, EVAR plus conservative management was associated with no benefit and more complications and subsequent procedures and higher costs compared to conservative management alone.[32]

The cigarette is the most common method of smoking tobacco. ... A sphygmomanometer, a device used for measuring arterial pressure. ... ACE inhibitors, or inhibitors of Angiotensin_Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ... Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower cholesterol levels in people with or at risk of cardiovascular disease. ... Intensive care medicine or critical care medicine is concerned with providing greater than ordinary medical care and observation to people in a critical or unstable condition. ... This article is about the economic and philosophical concept. ...

Research

Stanford University is conducting a study to gather information on AAA risk factors and to determine whether an exercise program reduces the rate of AAA enlargement.[1]


References

  1. ^ Upchurch GR, Schaub TA (2006). "Abdominal aortic aneurysm". Am Fam Physician 73 (7): 1198–204. PMID 16623206. 
  2. ^ Livesay JJ et al. Milestones in Treatment of Aortic Aneurysm. Tex Heart Inst J 2005; 32: 130–134. PMCID 1163455
  3. ^ Famous Patients, Famous Operations, 2002 - Part 3: The Case of the Scientist with a Pulsating Mass from Medscape Surgery
  4. ^ Wilmink TBM, Quick CRG, Day NE. The association between cigarette smoking and abdominal aortic aneurysms. J Vasc Surg 1999;30:1099-1105. PMID 10587395
  5. ^ a b c d e f Treska V. et al.:Aneuryzma břišní aorty, Prague, 1999, ISBN 80-7169-724-9
  6. ^ a b c d e f med/3443 at eMedicine
  7. ^ Baird PA, Sadovnick AD, Yee IM, Cole CW, Cole L. Sibling risks of abdominal aortic aneurysm. Lancet 1995;346:601-604. PMID 7651004
  8. ^ a b Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ 2005; 330: 750. PMCID: 555873
  9. ^ Clifton, MA: Familial abdominal aortic aneurysms. Br. J. Surg., 64, 1977, p. 765-766
  10. ^ U.S. Preventive Services Task Force (2005). "Screening for abdominal aortic aneurysm: recommendation statement". Ann. Intern. Med. 142 (3): 198-202. PMID 15684208. 
  11. ^ Fleming C, Whitlock EP, Beil TL, Lederle FA (2005). "Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force". Ann. Intern. Med. 142 (3): 203-11. PMID 15684209. ACP Journal Club
  12. ^ Recommendation ratings
  13. ^ Cinà CS, Devereaux PJ (2005). "Review: population-based screening for abdominal aortic aneurysm reduces cause-specific mortality in older men". ACP J. Club 143 (1): 11. PMID 15989299. 
  14. ^ a b Ashton HA, Buxton MJ, Day NE, et al (2002). "The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial". Lancet 360 (9345): 1531-9. PMID 12443589.  ACP Journal Club
  15. ^ Cina CS (2003). "Screening for abdominal aortic aneurysm reduced death from AAA in older men". ACP J. Club 138 (3): 66. PMID 12725621. 
  16. ^ Kim LG, P Scott RA, Ashton HA, Thompson SG (2007). "A sustained mortality benefit from screening for abdominal aortic aneurysm". Ann. Intern. Med. 146 (10): 699-706. PMID 17502630. 
  17. ^ Multicentre Aneurysm Screening Study Group (2002). "Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomized controlled trial". BMJ 325 (7373): 1135. PMID 12433761.  ACP Journal Club
  18. ^ Lindholt JS, Juul S, Fasting H, Henneberg EW (2005). "Screening for abdominal aortic aneurysms: single centre randomised controlled trial". BMJ 330 (7494): 750. doi:10.1136/bmj.38369.620162.82. PMID 15757960.  ACP Journal Club
  19. ^ Ashton HA, Gao L, Kim LG, Druce PS, Thompson SG, Scott RA (2007). "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms". The British journal of surgery 94 (6): 696-701. doi:10.1002/bjs.5780. PMID 17514666. 
  20. ^ Society for Vascular Surgery
  21. ^ O'Connor RE: Aneurysm, Abdominal, on emedicine, accessed June 23, 2006.
  22. ^ Brown LC, Powell JT, UK Small Aneurysm Trial Participants. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. Ann Surg 1999;230:289-297. PMID 10493476
  23. ^ Bown MJ, Sutton AJ, Bell PR, Sayers RD. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 2002;89:714-730. PMID 12027981
  24. ^ Hackam DG, Thiruchelvam D, Redelmeier DA. Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study. Lancet 2006;368:659-665. PMID 16920471
  25. ^ Powell JT, Brown LC, Greenhalgh RM, Thompson SG. The rupture rate of large abdominal aortic aneurysms: is this modified by anatomical suitability for endovascular repair? Ann Surg 2008;247:173-179. PMID 18156938
  26. ^ Powell JT, Brown LC, Forbes JF, et al. Final 12-year follow-up of patients enrolled in the UK Small Aneurysm Trial. Br J Surg 2007;94:702-708. PMID 17514693
  27. ^ Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346:1437-1444. PMID 12000813 Free full text
  28. ^ Rutherford RB. Randomized EVAR Trials and Advent of Level I Evidence: A Paradigm Shift in Management of Large Abdominal Aortic Aneurysms? Semin Vasc Surg 2006; 19:69-74. PMID 16782510
  29. ^ Lederle FA, Kane RL, MacDonald R, Wilt TJ (2007). "Systematic review: repair of unruptured abdominal aortic aneurysm". Ann. Intern. Med. 146 (10): 735-41. PMID 17502634. 
  30. ^ EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005;365:2179-2186. PMID 15978925
  31. ^ Blankensteijn JD, de Jong SECA, Prinssen M, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 2005;352:2398-2405. PMID 15944424 Free full text
  32. ^ EVAR Trial Participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005;365:2187-2192. PMID 15978926

eMedicine is an online clinical medical knowledge base that was founded in 1996. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

VIDEO: Factors that Influence Decision Making for Abdominal Aortic Aneurysm Repair Margaret L. Schwarze, MD, speaks at the University of Wisconsin School of Medicine and Public Health, 2007.


Further information on Endovascular Aneurysm Repair: Patient information

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and capillaries		 Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma - Dissection (Carotid artery, Vertebral artery)
Veins, lymphatic vessels
and lymph nodes		 Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis)
Other Hypotension (Orthostatic hypotension) - Rheumatic fever
See also congenital (Q20-Q28, 745-747)
For transport in plants, see Vascular tissue. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... For other forms of hypertension, see Hypertension (disambiguation). ... In kidney, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumens - hyaline arteriolosclerosis. ... While most forms of hypertension in humans have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... Renovascular hypertension (or renal hypertension) is a form of secondary hypertension. ... Ischaemic (or ischemic) heart disease is a disease characterized by reduced blood supply to the heart. ... Prinzmetals angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. ... Heart attack redirects here. ... Dresslers syndrome is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). ... Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-depleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. ... Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ... Grays Fig. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). ... Mitral regurgitation (MR), also known as mitral insufficiency, is the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart. ... Mitral valve prolapse (MVP) is a heart valve condition marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. ... Mitral stenosis is a narrowing of the orifice of the mitral valve of the heart. ... The aortic valve is one of the valves of the heart. ... Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ... Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ... The pulmonary valve, also known as pulmonic valve, is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. ... Pulmonary valve stenosis is a medical condition in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. ... Pulmonary valve insufficiency (or incompetence, or regurgitation) is a condition where the pulmonary valve is not strong enough to prevent backflow into the right ventricle. ... The tricuspid valve is on the right side of the heart, between the right atrium and the right ventricle. ... Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. ... Tricuspid insufficiency, also termed Tricuspid regurgitation, refers to the failure of the hearts tricuspid valve to close properly during systole. ... Myocardium is the muscular tissue of the heart. ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ... Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. ... Hypertrophic cardiomyopathy, or HCM, is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause. ... This article is considered orphaned, since there are very few or no other articles that link to this one. ... Restrictive cardiomyopathy (RCM) is the least common cardiomyopathy. ... Arrhythmogenic right ventricular dysplasia (ARVD, also known as arrhythmogenic right ventricular cardiomyopathy or ARVC) is a type of nonischemic cardiomyopathy that involves primarily the right ventricle. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... A heart block is a disease in the electrical system of the heart. ... A heart block denotes a disease in the electrical system of the heart. ... First degree AV block or PR prolongation is a disease of the electrical conduction system of the heart in which the PR interval is lengthened. ... Second degree AV block is a disease of the electrical conduction system of the heart. ... Third degree AV block, also known as complete heart block, is a defect of the electrical system of the heart, in which the impulse generated in the atria (typically the SA node on top of the right atrium) does not propagate to the ventricles. ... Bundle branch block refers to a disorder of the hearts electrical conducting system. ... ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. ... Right bundle branch block (RBBB) is a cardiac conduction abnormality seen on electrocardiogram (EKG). ... Bifascicular block is a conduction abnormality in the heart where two of the three main fascicles of the His/Purkinje system are blocked. ... Trifascicular heart block is the triad of first degree heart block, right bundle branch block, and either left anterior or left posterior hemi block seen on an electrocardiogram (EKG). ... Pre-excitation syndrome is a condition where the the ventricles of the heart become depolarized too early, which leads to their premature contraction, causing arrhythmia. ... Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the Bundle of Kent. ... Lown-Ganong-Levine syndrome (LGL) is a syndrome of pre-excitation of the ventricles due to an accessory pathway providing an abnormal electrical communication from the atria to the ventricles. ... The long QT syndrome (LQTS) is a heart disease in which there is an abnormally long delay between the electrical excitation (or depolarization) and relaxation (repolarization) of the ventricles of the heart. ... The term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. ... A cardiac arrest is the cessation of normal circulation of the blood due to failure of the ventricles of the heart to contract effectively during systole. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... A supraventricular tachycardia (SVT) is a rapid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node. ... AV nodal reentrant tachycardia (AVNRT) is a type of reentrant tachycardia (fast rhythm) of the heart. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Atrial flutter is an abnormal fast heart rhythm that occurs in the atria of the heart. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... pac This page meets Wikipedias criteria for speedy deletion. ... This article does not cite any references or sources. ... An ectopic pacemaker or ectopic focus is an excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the human heart. ... Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the hearts natural pacemaker. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Cardiomegaly is a medical condition wherein the heart is enlarged. ... Although ventricular hypertrophy may occur in either the left or right or both ventricles of the heart , left ventricular hypertrophy (LVH) is more commonly encountered. ... Left ventricular hypertrophy (LVH) is the thickening of the myocardium (muscle) of the left ventricle of the heart. ... Right ventricular hypertrophy (RVH) is a form of ventricular hypertrophy affecting the right ventricle. ... Cerebrovascular disease is damage to the blood vessels in the brain, resulting in a stroke. ... For other uses, see Stroke (disambiguation). ... A transient ischemic attack (TIA, often colloquially referred to as mini stroke) is caused by the temporary disturbance of blood supply to a restricted area of the brain, resulting in brief neurologic dysfunction that usually persists for less than 24 hours. ... This article needs cleanup. ... A intracranial hemorrhage is a bleed into the substance of the cerebrum. ... Extra-axial hematoma, or extra-axial hemorrhage is a subtype of intracranial hemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself. ... Nontraumatic epidural hematoma in a young woman. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Intraventricular hemorrhage (or IVH) is a bleeding of the ventricles, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral two-thirds of the spinal cord and Medulla. ... Binswangers disease is a rare form of multi-infarct dementia caused by damage to deep white brain matter. ... Moyamoya disease is an extremely rare disorder in most parts of the world except in Japan. ... Section of an artery An artery or arterial is also a class of highway. ... An arteriole is a blood vessel that extends and branchs out from an artery and leads to capillaries. ... The word capillary is used to describe any very narrow tube or channel through which a fluid can pass. ... Renal artery stenosis is the narrowing of the renal artery. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ... Post surgical photo of brain aneurysm survivor. ... Raynauds phenomenon (RAY-noz), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities, named for French physician Maurice Raynaud (1834 - 1881). ... Raynauds disease (RAY-noz) is a condition that affects blood flow to the extremities which include the fingers, toes, nose and ears when exposed to temperature changes or stress. ... Buergers disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ... Arteritis is inflammation of the walls of arteries, usually as a result of infection or auto-immune response. ... Aortitis is the inflammation of the aorta. ... Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. ... An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. ... In medicine, hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a genetic disorder that leads to vascular malformations. ... A spider angioma (also known as a nevus araneus, spider nevus, or vascular spider) is a type of angioma found slightly below the skins surface, often containing a central red spot and reddish extensions which radiate outwards like a spiders web. ... Carotid artery dissection is an important cause of stroke in young patients. ... In medical contexts, dissection refers to a tear in the wall of a blood vessel. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Lymph originates as blood plasma lost from the circulatory system, which leaks out into the surrounding tissues. ... Lymph nodes are components of the lymphatic system. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... Phlebitis is an inflammation of a vein, usually in the legs. ... It has been suggested that this article or section be merged into deep vein thrombosis. ... This article is about Deep-vein thrombosis. ... May-Thurner syndrome is deep vein thrombosis of the iliofemoral vein due to compression of the left common iliac vein by overlying right common iliac artery. ... A venous thrombosis is a blood clot that forms within a vein. ... In medicine (gastroenterology and hepatology), Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic vein. ... Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein, leading to a reduction in drainage of the kidney. ... Paget-Schroetter disease (also Paget-von Schrötter disease) refers to deep vein thrombosis of an upper extremity vein, including the axillary vein or subclavian vein. ... Vein gymnastics in the barefoot park Dornstetten, Germany. ... A portacaval anastomosis is a specific type of anastomosis that occurs between the veins of portal circulation and those of systemic circulation. ... Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Cross section showing the pampiniform plexus Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. ... Gastric varices are dilated submucosal veins in the stomach. ... Caput medusae means dilated veins around the umbilicus. ... Superior vena cava syndrome (SVCS) is a result of obstruction of the superior vena cava. ... Lymphadenopathy is a term meaning disease of the lymph nodes. ... Azskeptic 17:34, 10 July 2007 (UTC) Lymphedema, also spelled lymphoedema, also known as lymphatic obstruction, is a condition of localized fluid retention caused by a compromised lymphatic system. ... Lymphadenopathy is swelling of one or more lymph nodes. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Orthostatic hypotension (also known as postural hypotension, orthostatic intolerance and, colloquially, as head rush or a dizzy spell) is a sudden fall in blood pressure, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position, usually after a prolonged period of rest. ... Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...

  Results from FactBites:
 
Abdominal Aortic Aneurysm [May 1996; 27-3] (851 words)
Aortic diameters of 6 cm or more, and increase of diameter of 1 cm or more in a year, or developments of symptoms attributable to the aneurysm all constituted criteria for considering surgery.
The prevalence of aneurysm in the screened population was higher in men than women, and highest (at about 9%) in men in their eighth decade.
The incidence of ruptured aortic aneurysm in men over the follow-up period of five years showed a fall of more than 50% (9 of 3205 in scanned plus refused scan versus 20 of 3228 in control).
  More results at FactBites »


 

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