Medical Management of Small Abdominal Aortic Aneurysms

Abstract

Abstract-Abdominal aortic aneurysm is a common condition that may be lethal when it is unrecognized. Current guidelines suggest repair as the aneurysm diameter reaches 5.0 to 5.5 cm. Most aortic aneurysms are detected incidentally when imaging is done for other purposes or through screening programs. Ninety percent of these aneurysms are below the threshold for intervention at the time of detection. A number of studies have sought to determine factors that lead to progression of aneurysmal disease that might be amenable to intervention during this period of observation. We review these studies and make recommendations for the medical management of small abdominal aortic aneurysms. On the basis of our current knowledge of the causes of aneurysm, a number of approaches have been proposed to prevent progression of aneurysmal disease. These include hemodynamic management, inhibition of inflammation, and protease inhibition. The American College of Cardiology/American Heart Association clinical practice guidelines rules of evidence have helped to define strength of evidence to support these approaches. Level A evidence (from large randomized trials) is available to indicate that observation of small aneurysms in men is safe up to a size of 5.5 cm and that propranolol does not inhibit aneurysm expansion. Level B evidence (from small randomized trials) suggests that roxithromycin or doxycycline will decrease the rate of aneurysm expansion. A number of studies agree that tobacco use is associated with an increased rate of aneurysm expansion. Level B and C evidence is available to suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may inhibit aneurysm expansion. There are animal data but no human data demonstrating that angiotensin-converting enzyme inhibitors or losartan, an angiotensin receptor blocker, will decrease the rate of AAA expansion. A pharmacological agent without important side effects that inhibited aneurysm expansion could change current approaches to aneurysm treatment. Additional studies are needed to clarify the potential role of doxycycline, roxithromycin, and statin therapy in the progression of aneurysmal disease. Key Words: aneurysm Ⅲ aorta Ⅲ pharmacology Ⅲ antibiotics Ⅲ tetracycline A neurysmal degeneration of the abdominal aortic and iliac arteries (referred to as abdominal aortic aneurysm, or AAA) is a common and frequently lethal age-related disease process. The prevalences of unsuspected, asymptomatic AAA in men and women over the age of 60 years are 4% to 8% and 0.5% to 1.5%, respectively.

Association between Atrial Fibrillation and Aortic Aneurysms: A Population-Based Cohort Study

“…In the present study, the use of medications was balanced before any comparisons were made. Although certain medications, such as statins, renin-angiotensin-aldosterone inhibitors, and CCBs, have been shown to limit or attenuate experimental AAA in animal models [34-36], three recent trials reported no benefit of the antibiotic doxycycline, a mast cell inhibitor, an angiotensin-converting enzyme inhibitor, or a CCB in limiting AAA growth [37, 38]. There is no evidence that commonly used cardiovascular drugs have beneficial effects on AA progression [39, 40] Long-term warfarin treatment in endovascular aneurysm repair patients was associated with a statistically significant increase in endoleaks and persistent type II endoleaks, although it was not linked to an increased risk of reintervention [41, 42].…”

Angiotensin-Converting Enzyme 2 Decreases Formation and Severity of Angiotensin II–Induced Abdominal Aortic Aneurysms

“…Abdominal aortic aneurysms (AAAs) affect more than 1 million people in the United States 1, 2 There are no validated medical therapies that favorably impact aneurysm growth and rupture, making surgery the only available treatment option for AAAs. As AAA size increases, the risk of rupture increases, and ruptured aneurysms contribute to mortality rates of 60–80%.…”

Le pronostic cardio-vasculaire à un an des patients présentant un syndrome coronarien aigu est lié à l'anévrysme de l’aorte abdominal malgré sa petite taille

“…Jusqu'ici, il n'y a aucun consensus quant a la th erapie m edicale optimale chez les patients avec un AAA, bien que de nombreuses mol ecules, tels que le propranolol, les statines, des IEC, les macrolides, et les t etracyclines, aient et e examin es dans cette indication. [13][14][15] Les antiplaquettaires, tels que le ticagrelor, pourraient avoir la capacit e d'empêcher le d eveloppement de l'AAA en raison de leur action contre la formation du thrombus intra-luminal. 16 Des etudes pr esentant un effet b en efique des statines sur la progression des AAA 17 ont et e r ecemment remises en cause, 18 et on a sugg er e que les IEC pourraient r eellement augmenter le taux de croissance des petits AAA.…”