Do Hernias Contribute to Increased Severity of Aneurysmal Disease among Abdominal Aortic Aneurysm Patients?

Abstract

Background Connective tissue disorders could contribute to the pathogenesis of both abdominal aortic aneurysms (AAA) and hernias. We tested the hypothesis that hernias in AAA patients contribute to increased severity of the aneurysmal disease. Methods A questionnaire was used to collect information from 195 AAA patients divided into four groups: (1) survivors (n = 22) of ruptured AAA, (2) patients (n = 90) after elective open repair, (3) patients (n = 43) after elective endovascular repair (EVAR), and (4) patients (n = 40) under surveillance of AAA. The control group consisted of 100 patients without AAA whose abdominal computed tomography (CT) scans were examined for the presence of hernias. Mann–Whitney U-test, Chi-squared (χ 2) test, or Fisher's exact test (as appropriate) were used for statistical analyses. Multivariate logistic regression was used to control for potential confounding variables such as sex and age. Results The prevalence of inguinal hernias was significantly higher in the AAA than the control group (25 vs. 9%, p = 0.001) and did not differ between the AAA subgroups (9, 24, 35, and 23% in subgroups 1 through 4, respectively, p = 0.15) based on univariate analysis. The prevalence of inguinal hernias did not differ (p = 0.15) between the two open surgery groups (groups 1 and 2), or when comparing all three operative procedures as a combined group to group 4 (p = 0.73). The prevalences of incisional hernias were 18 and 24% for groups 1 and 2, respectively, with no significant difference (p = 0.39). Inguinal hernia demonstrated a significant association with AAA on multivariate analysis (p = 0.006; odds ratio [OR] = 4.00; 95% confidence interval [CI] = 1.49–10.66). Conclusions Our study confirms previous observations that patients with AAA have a high prevalence of hernias. Our results suggest that hernias do not contribute to increased severity of the aneurysmal disease.

No causal association between inguinal hernia and aortic aneurysm using Mendelian randomization analysis

“…Previous study by Cannon and colleagues in 1984 suggested a possible link between inguinal hernia and aortic aneurysm, which was then supported by many others [7,[24][25][26]. However, the results of conventional observational studies have been inconsistent.…”

“…Findings reveal that collagen levels are significantly lower in transversalis fascia samples derived from patients with inguinal hernia compared to controls. And the ratio of MMP to TIMP expression is higher in both inguinal hernia and AA, leading to ECM breakdown [26,28].…”

Incisional Hernias after Vascular Surgery for Aortoiliac Aneurysm and Aortoiliac Occlusive Arterial Disease: Has Prophylactic Mesh Changed This Scenario?

“…2,7,10,20 There are a few studies in the literature that compare the groups in terms of IH development between AAA and AOD, and it has been reported that the AAA group has a greater IH rate, up to a median of 5-fold increased risk. 7,8,21 In a study comparing AAA and AOD repair, a BMI of 25 kg/m 2 or higher was found to be an independent risk factor for IH. 10 Obesity is associated with a higher intraabdominal pressure and wound-healing complications as a consequence of decreased vascularity of adipose tissue.…”

“…The risk factors for IH are advanced age, male gender, BMI ≥ 27 kg/m 2 , diabetes, chronic obstructive pulmonary disease, chronic kidney disease, immunosuppression, use of corticosteroids, anemia, uremia, malnutrition, collagen-related diseases, smoking, neoplasia, surgical-site infection, abdominal aortic aneurysm, and emergency surgery. 8 16 17 18 19 Patients with abdominal aortic aneurysm and obese individuals are of especially high risk for IH development.…”

“…2,[4][5][6][7] Despite the similarity between the surgeries, a 3-to 5-fold increased risk of developing an IH after AAA surgery was demonstrated in a comparative study with those undergoing a similar medical condition treatment, such as aortoiliac occlusive disease (AOD) surgery. [6][7][8][9] The pathogenesis of AAA and abdominal wall hernias is multifactorial. The hypothesis of a higher incidence of hernias among patients undergoing AAA repair is based on the probable systemic disease of the connective tissue, a condition that is not present in AOD, where the cumulative incidence ranges between 3 and 17%.…”