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  • Review Article
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Pathophysiology and epidemiology of abdominal aortic aneurysms

Nature Reviews Cardiology volume 8, pages 92–102 (2011)Cite this article

Subjects

Abstract

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.

Key Points

  • Abdominal aortic aneurysms are a local representation of a systemic disease process

  • Ruptured abdominal aortic aneurysms continue to be associated with high mortality

  • Screening programs target men aged >65 years, as this group is at highest risk of developing an abdominal aortic aneurysm

  • The diameter of an abdominal aortic aneurysm is currently the only validated measure of rupture risk

  • Endovascular repair has substantially reduced perioperative morbidity and mortality of abdominal aortic aneurysms

  • Centralization of vascular surgical services has led to improved outcomes among patients with an abdominal aortic aneurysm

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Figure 1: Three-dimensional reconstruction of a CT angiogram showing a large abdominal aortic aneurysm and associated right common iliac artery aneurysm.
Figure 2: Distribution of screened individuals by age group and AAA size.
Figure 3: Estimates for total survival and aneurysm-related survival during 8 years of follow-up.

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References

  1. Johnston, K. W. et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J. Vasc. Surg. 13, 452–458 (1991).

    Article  CAS  PubMed  Google Scholar 

  2. Norman, P. E. & Powell, J. T. Site specificity of aneurysmal disease. Circulation 121, 560–568 (2010).

    Article  CAS  PubMed  Google Scholar 

  3. Ward, A. S. Aortic aneurysmal disease. A generalized dilating diathesis. Arch. Surg. 127, 990–991 (1992).

    Article  CAS  PubMed  Google Scholar 

  4. Crowther, M., Goodall, S., Jones, J. L., Bell, P. R. & Thompson, M. M. Increased matrix metalloproteinase 2 expression in vascular smooth muscle cells cultured from abdominal aortic aneurysms. J. Vasc. Surg. 32, 575–583 (2000).

    Article  CAS  PubMed  Google Scholar 

  5. Goodall, S., Crowther, M., Hemingway, D. M., Bell, P. R. & Thompson, M. M. Ubiquitous elevation of matrix metalloproteinase-2 expression in the vasculature of patients with aortic aneurysms. Circulation 104, 304–309 (2001).

    Article  CAS  PubMed  Google Scholar 

  6. Goodall, S., Crowther, M., Bell, P. R. & Thompson, M. M. The association between venous structural alterations and biomechanical weakness in patients with abdominal aortic aneurysms. J. Vasc. Surg. 35, 937–942 (2002).

    Article  PubMed  Google Scholar 

  7. Ballard, D. J., Filardo, G., Fowkes, G. & Powell, J. T. Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database of Systematic Reviews, Issue 4. Art No.: CD001835. doi: 10.1002/14651858.CD001835.pub2 (2008).

  8. Verhoeven, E. L. et al. Mortality of ruptured abdominal aortic aneurysm treated with open or endovascular repair. J. Vasc. Surg. 48, 1396–1400 (2008).

    Article  PubMed  Google Scholar 

  9. Basnyat, P. S., Biffin, A. H., Moseley, L. G., Hedges, A. R. & Lewis, M. H. Mortality from ruptured abdominal aortic aneurysm in Wales. Br. J. Surg. 86, 765–770 (1999).

    Article  CAS  PubMed  Google Scholar 

  10. Ashton, H. A. 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 360, 1531–1539 (2002).

    Article  CAS  PubMed  Google Scholar 

  11. Scott, R. A., Wilson, N. M., Ashton, H. A. & Kay, D. N. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Br. J. Surg. 82, 1066–1070 (1995).

    Article  CAS  PubMed  Google Scholar 

  12. Norman, P. E. et al. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ 329, 1259 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lindholt, J. S., Juul, S., Fasting, H. & Henneberg, E. W. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ 330, 750 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Powell, J. T. in Mechanisms of Vascular Disease: A Textbook for Vascular Surgeons (eds Fitridge, R. & Thompson, M. M.) 226–234 (Cambridge University Press, Cambridge, 2007).

    Google Scholar 

  15. Patel, M. I., Hardman, D. T., Fisher, C. M. & Appleberg, M. Current views on the pathogenesis of abdominal aortic aneurysms. J. Am. Coll. Surg. 181, 371–382 (1995).

    CAS  PubMed  Google Scholar 

  16. Nordon, I. et al. Evidence from cross-sectional imaging indicates abdominal but not thoracic aneurysms are local manifestations of a systemic dilating diathesis. J. Vasc. Surg. 50, 171–176.e1 (2009).

    Article  PubMed  Google Scholar 

  17. Hoshina, K., Sho, E., Sho, M., Nakahashi, T. K. & Dalman, R. L. Wall shear stress and strain modulate experimental aneurysm cellularity. J. Vasc. Surg. 37, 1067–1074 (2003).

    Article  PubMed  Google Scholar 

  18. Golledge, J. & Norman, P. E. Atherosclerosis and abdominal aortic aneurysm: cause, response, or common risk factors? Arterioscler. Thromb. Vasc. Biol. 30, 1075–1077 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Johnsen, S. H., Forsdahl, S. H., Singh, K. & Jacobsen, B. K. Atherosclerosis in abdominal aortic aneurysms: a causal event or a process running in parallel? The Tromsø study. Arterioscler. Thromb. Vasc. Biol. 30, 1263–1268 (2010).

    Article  CAS  PubMed  Google Scholar 

  20. Ailawadi, G., Eliason, J. L. & Upchurch, G. R. Jr. Current concepts in the pathogenesis of abdominal aortic aneurysm. J. Vasc. Surg. 38, 584–588 (2003).

    Article  PubMed  Google Scholar 

  21. Baxter, B. T. et al. Abdominal aortic aneurysms are associated with altered matrix proteins of the nonaneurysmal aortic segments. J. Vasc. Surg. 19, 797–802 (1994).

    Article  CAS  PubMed  Google Scholar 

  22. Makita, S. et al. Dilation and reduced distensibility of carotid artery in patients with abdominal aortic aneurysms. Am. Heart J. 140, 297–302 (2000).

    Article  CAS  PubMed  Google Scholar 

  23. Satoh, K. et al. Cyclophilin A enhances vascular oxidative stress and the development of angiotensin II-induced aortic aneurysms. Nat. Med. 15, 649–656 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. McCormick, M. L., Gavrila, D. & Weintraub, N. L. Role of oxidative stress in the pathogenesis of abdominal aortic aneurysms. Arterioscler. Thromb. Vasc. Biol. 27, 461–469 (2007).

    Article  CAS  PubMed  Google Scholar 

  25. Xiong, W. et al. Inhibition of reactive oxygen species attenuates aneurysm formation in a murine model. Atherosclerosis 202, 128–134 (2009).

    Article  CAS  PubMed  Google Scholar 

  26. Baxter, B. T., Terrin, M. C. & Dalman, R. L. Medical management of small abdominal aortic aneurysms. Circulation 117, 1883–1889 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zatina, M. A., Zarins, C. K., Gewertz, B. L. & Glagov, S. Role of medial lamellar architecture in the pathogenesis of aortic aneurysms. J. Vasc. Surg. 1, 442–448 (1984).

    Article  CAS  PubMed  Google Scholar 

  28. McDonald, D. A. Regional pulse-wave velocity in the arterial tree. J. Appl. Physiol. 24, 73–78 (1968).

    Article  CAS  PubMed  Google Scholar 

  29. Wolinsky, H. & Glagov, S. Nature of species differences in the medial distribution of aortic vasa vasorum in mammals. Circ. Res. 20, 409–421 (1967).

    Article  CAS  PubMed  Google Scholar 

  30. Dobrin, P. B., Baker, W. H. & Gley, W. C. Elastolytic and collagenolytic studies of arteries. Implications for the mechanical properties of aneurysms. Arch. Surg. 119, 405–409 (1984).

    Article  CAS  PubMed  Google Scholar 

  31. Johnson, S. H. et al. Relation of common carotid artery lumen diameter to general arterial dilating diathesis and abdominal aortic aneurysm: the Tromsø study. Am. J. Epidemiol. 169, 330–338 (2009).

    Article  Google Scholar 

  32. Wright, L. B. et al. Popliteal artery disease: diagnosis and treatment. Radiographics 24, 467–479 (2004).

    Article  PubMed  Google Scholar 

  33. Stajduhar, K. C., Laird, J. R., Rogan, K. M. & Wortham, D. C. Coronary arterial ectasia: increased prevalence in patients with abdominal aortic aneurysm as compared to occlusive atherosclerotic peripheral vascular disease. Am. Heart J. 125, 86–92 (1993).

    Article  CAS  PubMed  Google Scholar 

  34. Swaye, P. S. et al. Aneurysmal coronary artery disease. Circulation 67, 134–138 (1983).

    Article  CAS  PubMed  Google Scholar 

  35. Androulakis, A. E. et al. Varicose veins are common in patients with coronary artery ectasia. Just a coincidence or a systemic deficit of the vascular wall? Eur. J. Vasc. Endovasc. Surg. 27, 519–524 (2004).

    Article  CAS  PubMed  Google Scholar 

  36. Loftus, I. M. et al. Prevalence of true vein graft aneurysms: implications for aneurysm pathogenesis. J. Vasc. Surg. 29, 403–408 (1999).

    Article  CAS  PubMed  Google Scholar 

  37. Raffetto, J. D. et al. Incision and abdominal wall hernias in patients with aneurysm or occlusive aortic disease. J. Vasc. Surg. 37, 1150–1154 (2003).

    Article  PubMed  Google Scholar 

  38. McPhail, I. Abdominal aortic aneurysm and diastasis recti. Angiology 59, 736–739 (2008).

    Article  PubMed  Google Scholar 

  39. Lehnert, B. & Wadouh, F. High coincidence of inguinal hernias and abdominal aortic aneurysms. Ann. Vasc. Surg. 6, 134–137 (1992).

    Article  CAS  PubMed  Google Scholar 

  40. Cronenwett, J. L. Variables that affect the expansion rate and rupture of abdominal aortic aneurysms. Ann. N. Y. Acad. Sci. 800, 56–67 (1996).

    Article  CAS  PubMed  Google Scholar 

  41. McFarlane, M. J. The epidemiologic necropsy for abdominal aortic aneurysm. JAMA 265, 2085–2088 (1991).

    Article  CAS  PubMed  Google Scholar 

  42. Gillum, R. F. Epidemiology of aortic aneurysm in the United States. J. Clin. Epidemiol. 48, 1289–1298 (1995).

    Article  CAS  PubMed  Google Scholar 

  43. Ashton, H. A. et al. Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms. Br. J. Surg. 94, 696–701 (2007).

    Article  CAS  PubMed  Google Scholar 

  44. Scott, R. A., Bridgewater, S. G. & Ashton, H. A. Randomized clinical trial of screening for abdominal aortic aneurysm in women. Br. J. Surg. 89, 283–285 (2002).

    Article  CAS  PubMed  Google Scholar 

  45. Kent, K. C. et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J. Vasc. Surg. 52, 539–548 (2010).

    Article  PubMed  Google Scholar 

  46. Norman, P. E. & Powell, J. T. Abdominal aortic aneurysm: the prognosis in women is worse than in men. Circulation 115, 2865–2869 (2007).

    Article  CAS  PubMed  Google Scholar 

  47. Forsdahl, S. H., Singh, K., Solberg, S. & Jacobsen, B. K. Risk factors for abdominal aortic aneurysms: a 7-year prospective study: the Tromsø study, 1994–2001 Circulation 119, 2202–2208 (2009).

    Article  PubMed  Google Scholar 

  48. Vardulaki, K. A. et al. Incidence among men of asymptomatic aortic abdominal aneurysms: estimates from 500 screen detected cases. J. Med. Screen. 6, 50–54 (1999).

    Article  CAS  PubMed  Google Scholar 

  49. Lederle, F. A. et al. Yield of repeated screening for abdominal aortic aneurysm after a 4-year interval. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch. Intern. Med. 160, 1117–1121 (2000).

    Article  CAS  PubMed  Google Scholar 

  50. Salem, M. K. et al. Should Asian men be included in abdominal aortic aneurysm screening programmes? Eur. J. Vasc. Endovasc. Surg. 38, 748–749 (2009).

    Article  CAS  PubMed  Google Scholar 

  51. Earnshaw, J. J., Shaw, E., Whyman, M. R., Poskitt, K. R. & Heather, B. P. Screening for abdominal aneurysms in men. BMJ 328, 1122–1124 (2004).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Blanchard, J. F. Epidemiology of abdominal aortic aneurysms. Epidemiol. Rev. 21, 207–221 (1999).

    Article  CAS  PubMed  Google Scholar 

  53. Centers for Disease Control and Prevention National Center for Health Statistics. Compressed Mortality, 1999–2006 CDC WONDER Database [online], (2009).

  54. Acosta, S. et al. Increasing incidence of ruptured abdominal aortic aneurysm: a population-based study. J. Vasc. Surg. 44, 237–243 (2006).

    Article  PubMed  Google Scholar 

  55. Brady, A. R., Thompson, S. G., Fowkes, F. G., Greenhalgh, R. M. & Powell, J. T. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 110, 16–21 (2004).

    Article  PubMed  Google Scholar 

  56. Palazzuoli, A. et al. Prevalence of risk factors, coronary and systemic atherosclerosis in abdominal aortic aneurysm: comparison with high cardiovascular risk population. Vasc. Health Risk Manag. 4, 877–883 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  57. Vardulaki, K. A. et al. Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm. Br. J. Surg. 87, 195–200 (2000).

    Article  CAS  PubMed  Google Scholar 

  58. Lederle, F. A., Johnson, G. R. & Wilson, S. E. for the Aneurysm Detection and Management Veterans Affairs Cooperative Study. Abdominal aortic aneurysm in women. J. Vasc. Surg. 34, 122–126 (2001).

    Article  CAS  PubMed  Google Scholar 

  59. Cosford, P. A. & Leng, G. C. Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD002945. doi: 10.1002/14651858.CD002945.pub2 (2007).

    Google Scholar 

  60. Blanchard, J. F., Armenian, H. K. & Friesen, P. P. Risk factors for abdominal aortic aneurysm: results of a case-control study. Am. J. Epidemiol. 151, 575–583 (2000).

    Article  CAS  PubMed  Google Scholar 

  61. Clifton, M. A. Familial abdominal aortic aneurysms. Br. J. Surg. 64, 765–766 (1977).

    Article  CAS  PubMed  Google Scholar 

  62. Ogata, T. et al. The lifetime prevalence of abdominal aortic aneurysms among siblings of aneurysm patients is eightfold higher than among siblings of spouses: an analysis of 187 aneurysm families in Nova Scotia, Canada. J. Vasc. Surg. 42, 891–897 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  63. Frydman, G. et al. The value of screening in siblings of patients with abdominal aortic aneurysm. Eur. J. Vasc. Endovasc. Surg. 26, 396–400 (2003).

    Article  CAS  PubMed  Google Scholar 

  64. Larsson, E., Granath, F., Swedenborg, J. & Hultgren, R. A population-based case-control study of the familial risk of abdominal aortic aneurysm. J. Vasc. Surg. 49, 47–50 (2009).

    Article  PubMed  Google Scholar 

  65. Lederle, F. A., Nelson, D. B. & Joseph, A. M. Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review. J. Vasc. Surg. 38, 329–334 (2003).

    Article  PubMed  Google Scholar 

  66. Wilmink, T. B., Quick, C. R. & Day, N. E. The association between cigarette smoking and abdominal aortic aneurysms. J. Vasc. Surg. 30, 1099–1105 (1999).

    Article  CAS  PubMed  Google Scholar 

  67. Wong, D. R., Willett, W. C. & Rimm, E. B. Smoking, hypertension, alcohol consumption, and risk of abdominal aortic aneurysm in men. Am. J. Epidemiol. 165, 838–845 (2007).

    Article  PubMed  Google Scholar 

  68. MacSweeney, S. T., Ellis, M., Worrell, P. C., Greenhalgh, R. M. & Powell, J. T. Smoking and growth rate of small abdominal aortic aneurysms. Lancet 344, 651–652 (1994).

    Article  CAS  PubMed  Google Scholar 

  69. MacSweeney, S. T., Powell, J. T. & Greenhalgh, R. M. Pathogenesis of abdominal aortic aneurysm. Br. J. Surg. 81, 935–941 (1994).

    Article  CAS  PubMed  Google Scholar 

  70. Knuutinen, A. et al. Smoking affects collagen synthesis and extracellular matrix turnover in human skin. Br. J. Dermatol. 146, 588–594 (2002).

    Article  CAS  PubMed  Google Scholar 

  71. Iribarren, C. et al. Traditional and novel risk factors for clinically diagnosed abdominal aortic aneurysm: the Kaiser multiphasic health checkup cohort study. Ann. Epidemiol. 17, 669–678 (2007).

    Article  PubMed  Google Scholar 

  72. Pleumeekers, H. J. et al. Aneurysms of the abdominal aorta in older adults. The Rotterdam Study. Am. J. Epidemiol. 142, 1291–1299 (1995).

    Article  CAS  PubMed  Google Scholar 

  73. Sagiv, M. & Goldbourt, U. Influence of physical work on high density lipoprotein cholesterol: implications for the risk of coronary heart disease. Int. J. Sports Med. 15, 261–266 (1994).

    Article  CAS  PubMed  Google Scholar 

  74. Schouten, O. et al. Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. Eur. J. Vasc. Endovasc. Surg. 32, 21–26 (2006).

    Article  CAS  PubMed  Google Scholar 

  75. Wanhainen, A. et al. Risk factors associated with abdominal aortic aneurysm: a population-based study with historical and current data. J. Vasc. Surg. 41, 390–396 (2005).

    Article  PubMed  Google Scholar 

  76. Cornuz, J., Sidoti Pinto, C., Tevaearai, H. & Egger, M. Risk factors for asymptomatic abdominal aortic aneurysm: systematic review and meta-analysis of population-based screening studies. Eur. J. Public Health 14, 343–349 (2004).

    Article  PubMed  Google Scholar 

  77. Brown, L. C. & Powell, J. T. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann. Surg. 230, 289–296 (1999).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Gadowski, G. R., Ricci, M. A., Hendley, E. D. & Pilcher, D. B. Hypertension accelerates the growth of experimental aortic aneurysms. J. Surg. Res. 54, 431–436 (1993).

    Article  CAS  PubMed  Google Scholar 

  79. Golledge, J., Clancy, P., Jamrozik, K. & Norman, P. E. Obesity, adipokines, and abdominal aortic aneurysm: Health in Men study. Circulation 116, 2275–2279 (2007).

    Article  CAS  PubMed  Google Scholar 

  80. Long, A. et al. Prevalence of abdominal aortic aneurysm and large infrarenal aorta in patients with acute coronary syndrome and proven coronary stenosis: a prospective monocenter study. Ann. Vasc. Surg. 24, 602–608 (2010).

    Article  PubMed  Google Scholar 

  81. Partridge, C. R., Sampson, H. W. & Forough, R. Long-term alcohol consumption increases matrix metalloproteinase-2 activity in rat aorta. Life Sci. 65, 1395–1402 (1999).

    Article  CAS  PubMed  Google Scholar 

  82. Koksal, C., Ercan, M., Bozkurt, A. K., Cortelekoglu, T. & Konukoglu, D. Abdominal aortic aneurysm or aortic occlusive disease: role of trace element imbalance. Angiology 58, 191–195 (2007).

    Article  CAS  PubMed  Google Scholar 

  83. Badger, S. A. et al. Risk factors for abdominal aortic aneurysm and the influence of social deprivation. Angiology 59, 559–566 (2008).

    Article  PubMed  Google Scholar 

  84. Lederle, F. A. et al. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann. Intern. Med. 126, 441–449 (1997).

    Article  CAS  PubMed  Google Scholar 

  85. Shantikumar, S., Ajjan, R., Porter, K. E. & Scott, D. J. Diabetes and abdominal aortic aneurysm. Eur. J. Vasc. Endovasc. Surg. 39, 200–207 (2010).

    Article  CAS  PubMed  Google Scholar 

  86. Golledge, J. et al. Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte–matrix interactions. Eur. Heart J. 29, 665–672 (2008).

    Article  CAS  PubMed  Google Scholar 

  87. Norman, P. E., Davis, T. M., Le, M. T. & Golledge, J. Matrix biology of abdominal aortic aneurysms in diabetes: mechanisms underlying the negative association. Connect. Tissue Res. 48, 125–131 (2007).

    Article  CAS  PubMed  Google Scholar 

  88. Astrand, H., Rydén-Ahlgren, A., Sundkvist, G., Sandgren, T. & Länne, T. Reduced aortic wall stress in diabetes mellitus. Eur. J. Vasc. Endovasc. Surg. 33, 592–598 (2007).

    Article  CAS  PubMed  Google Scholar 

  89. Salo, J. A., Soisalon-Soininen, S., Bondestam, S. & Mattila, P. S. Familial occurrence of abdominal aortic aneurysm. Ann. Intern. Med. 130, 637–642 (1999).

    Article  CAS  PubMed  Google Scholar 

  90. Wahlgren, C. M., Larsson, E., Magnusson, P. K., Hultgren, R. & Swedenborg, J. Genetic and environmental contributions to abdominal aortic aneurysm development in a twin population. J. Vasc. Surg. 51, 3–7 (2010).

    Article  PubMed  Google Scholar 

  91. Aneurysm Consortium. Genome wide association studies: identifying the genes that determine the risk of abdominal aortic aneurysm. Eur. J. Vasc. Endovasc. Surg. 36, 395–396 (2008).

  92. Thompson, A. R., Drenos, F., Hafez, H. & Humphries, S. E. Candidate gene association studies in abdominal aortic aneurysm disease: a review and meta-analysis. Eur. J. Vasc. Endovasc. Surg. 35, 19–30 (2008).

    Article  CAS  PubMed  Google Scholar 

  93. Gretarsdottir, S. et al. Genome-wide association study identifies a sequence variant within the DAB2IP gene conferring susceptibility to abdominal aortic aneurysm. Nat. Genet. 42, 692–697 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Helgadottir, A. et al. The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm. Nat. Genet. 40, 217–224 (2008).

    Article  CAS  PubMed  Google Scholar 

  95. Biros, E. et al. Association of an allele on chromosome 9 and abdominal aortic aneurysm. Atherosclerosis 212, 539–542 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  96. Powell, J. T., Brown, L. C., Greenhalgh, R. M. & Thompson, S. G. The rupture rate of large abdominal aortic aneurysms: is this modified by anatomical suitability for endovascular repair. Ann. Surg. 247, 173–179 (2008).

    Article  PubMed  Google Scholar 

  97. McGloughlin, T. M. & Doyle, B. J. New approaches to abdominal aortic aneurysm rupture risk assessment: engineering insights with clinical gain. Arterioscler. Thromb. Vasc. Biol. 30, 1687–1694 (2010).

    Article  CAS  PubMed  Google Scholar 

  98. Engström, G., Börner, G., Lindblad, B., Janzon, L. & Lindgärde, F. Incidence of fatal or repaired abdominal aortic aneurysm in relation to inflammation-sensitive plasma proteins. Arterioscler. Thromb. Vasc. Biol. 24, 337–341 (2004).

    Article  PubMed  CAS  Google Scholar 

  99. [No authors listed] Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. Lancet 352, 1649–1655 (1998).

  100. Lederle, F. A. et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA 287, 2968–2972 (2002).

    Article  PubMed  Google Scholar 

  101. Thompson, A. R., Cooper, J. A., Ashton, H. A. & Hafez, H. Growth rates of small abdominal aortic aneurysms correlate with clinical events. Br. J. Surg. 97, 37–44 (2010).

    Article  CAS  PubMed  Google Scholar 

  102. Hackam, D. G., Thiruchelvam, D. & Redelmeier, D. A. Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study. Lancet 368, 659–665 (2006).

    Article  CAS  PubMed  Google Scholar 

  103. Freiberg, M. S. et al. Abdominal aortic aneurysms, increasing infrarenal aortic diameter, and risk of total mortality and incident cardiovascular disease events: 10-year follow-up data from the Cardiovascular Health Study. Circulation 117, 1010–1017 (2008).

    Article  PubMed  Google Scholar 

  104. Propranolol Aneurysm Trial Investigators. Propranolol for small abdominal aortic aneurysms: results of a randomized trial. J. Vasc. Surg. 35, 72–79 (2002).

  105. Baxter, B. T. et al. Prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms: report of a prospective (phase II) multicenter study. J. Vasc. Surg. 36, 1–12 (2002).

    Article  PubMed  Google Scholar 

  106. The Vascular Society of Great Britain and Ireland. National Vascular Database—2009 report [online], (2009).

  107. Vallabhaneni, S. R. & Harris, P. L. Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair. Eur. J. Radiol. 39, 34–41 (2001).

    Article  CAS  PubMed  Google Scholar 

  108. Thomas, S. M. et al. Results from the prospective registry of endovascular treatment of abdominal aortic aneurysms (RETA): mid term results to five years. Eur. J. Vasc. Endovasc. Surg. 29, 563–570 (2005).

    Article  CAS  PubMed  Google Scholar 

  109. EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365, 2179–2186 (2005).

  110. Prinssen, M. et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N. Engl. J. Med. 351, 1607–1618 (2004).

    Article  CAS  PubMed  Google Scholar 

  111. Lederle, F. A. et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 302, 1535–1542 (2009).

    Article  CAS  PubMed  Google Scholar 

  112. Albuquerque, F. C. Jr et al. Paradigm shifts in the treatment of abdominal aortic aneurysm: trends in 721 patients between 1996 and 2008. J. Vasc. Surg. 51, 1348–1352 (2010).

    Article  PubMed  Google Scholar 

  113. Veith, F. J. et al. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Ann. Surg. 250, 818–824 (2009).

    Article  PubMed  Google Scholar 

  114. Hoornweg, L.L., Wisselink, W., Vahl, A. & Balm, R. for the Amsterdam Acute Aneurysm Trial Collaborators. The Amsterdam Acute Aneurysm Trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms. Eur. J. Vasc. Endovasc. Surg. 33, 679–683 (2007).

    Article  CAS  PubMed  Google Scholar 

  115. Desgranges, P. et al. The Endovasculaire vs Chirurgie dans les Anévrysmes Rompus PROTOCOL trial update. J. Vasc. Surg. 51, 267–270 (2010).

    Article  PubMed  Google Scholar 

  116. Patterson, B. O., Holt, P. J., Hinchliffe, R., Loftus, I. M. & Thompson, M. M. Predicting risk in elective abdominal aortic aneurysm repair: a systematic review of current evidence. Eur. J. Vasc. Endovasc. Surg. 36, 637–645 (2008).

    Article  CAS  PubMed  Google Scholar 

  117. Tang, T. Y. et al. POSSUM models in open abdominal aortic aneurysm surgery. Eur. J. Vasc. Endovasc. Surg. 34, 499–504 (2007).

    Article  CAS  PubMed  Google Scholar 

  118. Hirzalla, O., Emous, M., Ubbink, D. T. & Legemate, D. External validation of the Glasgow Aneurysm Score to predict outcome in elective open abdominal aortic aneurysm repair. J. Vasc. Surg. 44, 712–716 (2006).

    Article  PubMed  Google Scholar 

  119. Stanley, B. M. et al. Evaluation of patient selection guidelines for endoluminal AAA repair with the Zenith Stent-Graft: the Australasian experience. J. Endovasc. Ther. 8, 457–464 (2001).

    Article  CAS  PubMed  Google Scholar 

  120. Holt, P. J., Poloniecki, J. D., Loftus, I. M., Michaels, J. A. & Thompson, M. M. Epidemiological study of the relationship between volume and outcome after abdominal aortic aneurysm surgery in the UK from 2000 to 2005. Br. J. Surg. 94, 441–448 (2007).

    Article  CAS  PubMed  Google Scholar 

  121. Holt, P. J. et al. Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm. Br. J. Surg. 97, 496–503 (2010).

    Article  CAS  PubMed  Google Scholar 

  122. Birkmeyer, J. D. et al. Surgeon volume and operative mortality in the United States. N. Engl. J. Med. 349, 2117–2127 (2003).

    Article  CAS  PubMed  Google Scholar 

  123. Schlösser, F. J. et al. Mortality after elective abdominal aortic aneurysm repair. Ann. Surg. 251, 158–164 (2010).

    Article  PubMed  Google Scholar 

  124. Egorova, N. et al. Defining high-risk patients for endovascular aneurysm repair. J. Vasc. Surg. 50, 1271–1279.e1 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  125. Schwarze, M. L., Shen, Y., Hemmerich, J. & Dale, W. Age related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006. J. Vasc. Surg. 50, 722–729.e2 (2009).

    Article  PubMed  Google Scholar 

  126. Wolf, Y. G. et al. Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. J. Vasc. Surg. 35, 882–886 (2002).

    Article  PubMed  Google Scholar 

  127. Heikkinen, M., Salenius, J. P. & Auvinen, O. Ruptured abdominal aortic aneurysm in a well-defined geographical area. J. Vasc. Surg. 36, 291–296 (2002).

    Article  CAS  PubMed  Google Scholar 

  128. Brewster, D. C. et al. Long-term outcomes after endovascular abdominal aortic aneurysm repair: the first decade. Ann. Surg. 244, 426–438 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  129. Mureebe, L., Egorova, N., McKinsey, J. F. & Kent, K. C. Gender trends in the repair of ruptured abdominal aortic aneurysms and outcomes. J. Vasc. Surg. 51 (4 Suppl.), 9S–13S (2010).

    Article  PubMed  Google Scholar 

  130. Kennedy, N. A. et al. The evaluation of morbidity and mortality in abdominal aortic aneurysm repair patients as related to body mass index. Am. J. Surg. 199, 369–371 (2010).

    Article  PubMed  Google Scholar 

  131. Jonker, F. H. et al. Abdominal aortic aneurysm repair in obese patients: improved outcome after endovascular treatment compared with open surgery. Vasc. Endovascular Surg. 44, 105–109 (2010).

    Article  PubMed  Google Scholar 

  132. Smith, S. T. et al. Percutaneous access for endovascular abdominal aortic aneurysm repair: can selection criteria be expanded? Ann. Vasc. Surg. 23, 621–626 (2009).

    Article  PubMed  Google Scholar 

  133. Beck, A. W. et al. Predicting 1-year mortality after elective abdominal aortic aneurysm repair. J. Vasc. Surg. 49, 838–843 (2009).

    Article  PubMed  Google Scholar 

  134. Black, S. A. et al. Assessing the impact of renal impairment on outcome after arterial intervention: a prospective review of 1,559 patients. Eur. J. Vasc. Endovasc. Surg. 32, 300–304 (2006).

    Article  CAS  PubMed  Google Scholar 

  135. Hadjianastassiou, V. G., Tekkis, P. P., Goldhill, D. R. & Hands, L. J. Quantification of mortality risk after abdominal aortic aneurysm repair. Br. J. Surg. 92, 1092–1098 (2005).

    Article  CAS  PubMed  Google Scholar 

  136. Ridgway, Z. A. & Howell, S. J. Cardiopulmonary exercise testing: a review of methods and applications in surgical patients. Eur. J. Anaesthesiol. 27, 858–865 (2010).

    Article  PubMed  Google Scholar 

  137. Carlisle, J. & Swart, M. Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing. Br. J. Surg. 94, 966–969 (2007).

    Article  CAS  PubMed  Google Scholar 

  138. Louwrens, H. D., Adamson, J., Powell, J. T. & Greenhalgh, R. M. Risk factors for atherosclerosis in men with stenosing or aneurysmal disease of the abdominal aorta. Int. Angiol. 12, 21–24 (1993).

    CAS  PubMed  Google Scholar 

  139. Alcorn, H. G., Wolfson, S. K. Jr, Sutton-Tyrrell, K., Kuller, L. H. & O'Leary, D. Risk factors for abdominal aortic aneurysms in older adults enrolled in the Cardiovascular Health Study. Arterioscler. Thromb. Vasc. Biol. 16, 963–970 (1996).

    Article  CAS  PubMed  Google Scholar 

  140. Lee, A. J., Fowkes, F. G., Carson, M. N., Leng, G. C. & Allan, P. L. Smoking, atherosclerosis and the risk of abdominal aortic aneurysm. Eur. Heart J. 18, 671–676 (1997).

    Article  CAS  PubMed  Google Scholar 

  141. Törnwall, M. E., Vitamo, J., Haukka, J. K., Albanes, D. & Huttunen, J. K. Life-style factors and risk for abdominal aortic aneurysm in a cohort of Finnish male smokers. Epidemiology 12, 94–100 (2001).

    Article  PubMed  Google Scholar 

  142. Singh, K., Bønaa, K. H., Jacobsen, B. K., Bjørk, L. & Solberg, S. Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: The Tromsø Study. Am. J. Epidemiol. 154, 236–244 (2001).

    Article  CAS  PubMed  Google Scholar 

  143. Le, M. T., Jamrozik, K., Davis, T. M. & Norman, P. E. Negative association between infra-renal aortic diameter and glycaemia: the Health in Men Study. Eur. J. Vasc. Endovasc. Surg. 33, 599–604 (2007).

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. St. George's Vascular Institute, St. James' Wing, St. George's Hospital, Blackshaw Road, SW17 0QT, London, UK

    Ian M. Nordon, Robert J. Hinchliffe, Ian M. Loftus & Matt M. Thompson

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  2. Robert J. Hinchliffe
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All the authors contributed to discussion of content for the article. I. M. Nordon researched data to include in the manuscript, wrote the manuscript, and revised the manuscript in response to the peer-reviewers' comments. R. J. Hinchliffe and I. M. Loftus wrote the manuscript and reviewed and edited the manuscript before submission. M. M. Thompson reviewed and edited the manuscript before submission.

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Correspondence to Matt M. Thompson.

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M. M. Thompson is a consultant for Cook Medical and Medtronic. The other authors declare no competing interests.

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Nordon, I., Hinchliffe, R., Loftus, I. et al. Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol 8, 92–102 (2011). https://doi.org/10.1038/nrcardio.2010.180

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