Diagnostic and therapeutic strategies for small abdominal aortic aneurysms

Abstract

Abdominal aortic aneurysms (AAA) affect 5% of the population in developed countries and are characterized by progressive aortic dilatation with an unpredictable time course. This condition is more common in men than in women, and in smokers than in nonsmokers. If left untreated, AAA can result in aortic rupture and death. Pathologically, aortic extracellular matrix degradation, inflammation, and neovascularization are hallmarks of AAA. Diagnosis of AAA and subsequent surveillance utilize established aortic imaging methods, such as ultrasound, CT, and MRI. More-speculative diagnostic approaches include molecular and cellular imaging methods that interrogate the underlying pathological processes at work within the aneurysm. In this Review, we explore the current diagnostic and therapeutic strategies for the management of AAA. We also describe the diagnostic potential of new imaging techniques and therapeutic potential of new treatments for the management of small AAA.

Role of miR-195 in Aortic Aneurysmal Disease

“…Better diagnostic tools are urgently needed to identify patients at risk, monitor disease progression, and implement novel therapeutic and preemptive strategies. [25][26][27] Identification of those patients with AAAs at risk of subsequent expansion or rupture by a simple cheap noninvasive method of predicting subsequent AAA growth would meet an important clinical need. Once AAA is diagnosed, patients at high risk may be treated with earlier surgical repair to prevent rupture.…”

Predicting Aortic Aneurysm Expansion by PET

“…Only smoking cessation has been shown to slow AAA growth rate (9). At present, AAA size is the best predictor of rupture, but some patients have smaller AAAs that do rupture (10).…”

“…To improve risk stratification and to guide intervention and development of new disease-modifying drugs, a better understanding of the underlying pathology leading to expansion and rupture is warranted (10). This presents a role for noninvasive imaging, particularly where anatomy and pathophysiology can be assessed in a single test.…”

Can FDG-PET imaging play a role in guiding indications to endovascular treatments in patients presenting acute aortic syndromes?

“…[8][9][10] In atherosclerotic plaques, the intensity of FDG uptake is related to the degree of macrophage infiltration. In acute aortic syndrome, the FDG signal might rather originate from an inflammatory reaction in the adventitia.…”