abdominal aortic aneurysm (AAA)
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Etiology
- see aortic aneurysm
- advanced age, smoking, male sex, atherosclerosis, hypertension & family history most important risk factors
- higher diastolic blood pressure associated with increased risk[31]
* diabetes mellitus associated with decreased risk[33]
Epidemiology
- see aortic aneurysm
- growth & rupture rates may be faster in women than men
- mean aneurysm diameter at the time of repair smaller in the U.S. than the U.K.
- twice as many intact AAAs repaired in U.S. than in the U.K.
- AAA-related mortality > 3X as high in the U.K. as in the U.S.[42]
Pathology
- degenerative changes in the aortic wall
- chronic inflammation
- destructive remodeling of the extracellular matrix
- destruction of elastin & collagen in the media & adventitia by matrix metalloproteinases
- depletion of vascular smooth muscle cells with thinning of the media
- neovascularization
* aortic dissection is a distinct process
- most often involves the thoracic aorta
- rarely the source of aneurysms isolated to the infrarenal aorta[32]
Genetics
- defects in COL3A1 associated with susceptibility
Clinical manifestations
- most patients are asymptomatic
- symptoms when they do occur include:
- abdominal discomfort
- back pain
- pain in the legs, groin or chest
- anorexia, nausea/vomiting if the aneurysm compresses the duodenum
- flank, thigh or scrotal pain from compression of the left genitofemoral nerve
- unilateral leg swelling caused by compression of the left iliac vein
- syncope, shock
Diagnostic procedures
Radiology
- abdominal ultrasound (US) -> abdominal aorta US
- identify maximum diameter
- not for identification of aneurysm rupture
- follow-up abdominal ultrasound (unrepaired AAA)
- abdominal CT or MRI
- caudal-cephalic extent
- patency of renal arteries
- status of celiac, superior & inferior mesenteric arteries
- extension into the iliac arteries
- non-contast CT useful if renal insufficiency
- aneurysm rupture
- maximal AAA diameter ~1 cm larger by CT than US[5]
- normal abdominal aorta size is 1.4-3.0 cm
- CT angiography abdomen & pelvis
- identify involvement of renal artery & mesenteric arteries[2]
- indicated for planning surgical repair[2]
- suprarenal & juxtarenal aneurysms most often necessitate open repair[2]
- abdominal aorta CT angiogram (Loinc)
- MRA abdominal aorta (Loinc)
- identify involvement of renal artery & mesenteric arteries[2]
* annual growth of AAA 3.5-5.0 cm (men), 3.5-4.5 cm (women)[48]
- median growth rate is 0.17 cm per year
- 10% show < 0.05 cm per year
- 28% show > 0.25 cm per year
- no patient with maximum diameter < 4.25 cm reached threshold for surgical repair within 2 years (5.0 cm women, 5.5 cm men)[48]
* heavy calcification is associated with slower growth[51]
Complications
- sudden death
- rupture of aneurysm
- annual incidence of < 0.5% for aneurysms < 4.0 cm[2]
- annual incidence of 0.5-5% for aneurysms 4.0-4.9 cm
- annual incidence of 3-15% for aneurysms 5.0-5.9 cm
- annual incidence of 10-20% for aneurysms 6.0-6.9 cm
- annual incidence of 30-40% for aneurysms 7.0-9.9 cm
- annual incidence of 30-50% for aneurysms >= 8.0 cm[2]
- incidence of 1% for men, 4% for women for aneurysms 5.0-5.9 cm
- incidence of 14% for men, 22% for women for aneurysms > 5.9 cm
- abdominal pain, back pain & syncope may herald an AAA rupture[2]
- endovascular repair with similar outcomes to open repair][29]
- distal embolization (emboli often small)[3]
- aortic diameter of 2.5-2.9 cm is associated with
- excess risk of hospitalization
- 30% chance of developing AAA[20]
- aortic diameter >= 3.0 is associated with excess risk of mortality [RR = 2.6)[20]
- aortoenteric fistula with repair of AAA
Management
- also see aortic aneurysm
- target modifiable risk factors: smoking cessation
- presence of intramural thrombus is not an indication for anticoagulation[54]
- aneurysms < 5.5 cm in diameter (men), < 5.0 cm (women)[1][33]
- may be closely observed
- endovascular repair of aneurysms < 5.5 cm in diameter does not improve mortality[18]
- surveillance imaging (US) every 12 months for AAA 4.0-4.9 cm to assess progression & need for surgery [43)
- assessment of femoral artery & popliteal artery
- treat hypertension
- ACE inhibitor may reduce risk of rupture (RR=0.82)[12]
- no evidence supports preferential use of beta-blockers[2]
- no benefit of statins[27] or doxycycline[30] in slowing progression of AAA
- surgery
- indications
- preoperative cardiac stress testing does not reduce perioperative cardiac events or improve outcomes[49]
- procedures
- open surgery
- endovascular stent-graft via femoral arteriotomy
- lifelong surveillance, including imaging, for patients with AAA endovascular aortic repair with endovascular stent; imaging within 30-days 7 annually thereafter[50]
- perioperative mortality may be less with endovascular repair, 1.2% vs 4.8%[14][16][17][32][41]
- long-term mortality advantage for endovascular repair may persist in patients >= 85 years of age[14]
- no difference in long-term mortality[17][19][23][33][41]
- patients treated with endovascular repair require long-term surveillance owing to a small risk of aneurysm sac reperfusion & late rupture[33][41]
- late rupture occurs in 5.4% after endovascular repair vs 1.4% after open repair[36]
- endovascular repair is associated with lower short-term mortality but more secondary surgical procedures during follow-up[46]
- not all patients have anatomy amenable to endovascular repair[33]
- involvement of renal artery or mesenteric artery favors open repair
- open repair for supra-renal & juxta-renal aneurysms[2]
- continuation of dual antiplatelet therapy with endovascular repair if < 6 months after placement of drug-eluting coronary stent[43]
- Aneurex & Ancure stent grafts FDA approved Sept 1999
- see Endovascular Aneurysm Repair & DREAM trials
- anesthesia:
- local vs general anesthesia
- octogenarians fare better under local anesthesia for elective endovascular aortic aneurysm repair[55]
- complications of surgical repair:
- screening
- one time screening for men age 65-75 who have smoked > 100 cigarettes[2][9][10][15][24][32][47] (USPSTF 2014, 2019)
- selective screening for men aged 65-75 who have never smoked[32][47] (USPSTF)
- evidence is insufficient to assess benefits vs harms of screening for women aged 65-75 years who have ever smoked[32][47] (USPSTF)
- USPSTF recommends against routine screening for women who have never smoked [32][47] (2014)
- screening reduces mortality from AAA in men > 65 years
- 352 screenings to save one life[11]
- screening is cost-effective[21]
- screening twice in men with aortic diameters of 25-29 mm at initial screening may also be cost-effective[22]
- no consensus on screening[6][7][9] (2002-2004)
More general terms
More specific terms
Additional terms
- endovascular graft (endovascular repair)
- repair of abdominal aortic aneurysm
- screening for abdominal aortic aneurysm (AAA)
References
- ↑ 1.0 1.1 1.2 Journal Watch, Mass Med Soc 20(1):7 (Jan 1) 2000
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2915, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 3.0 3.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ Journal Watch 23(8):64, 2003 Brown PM et al The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg 37:280, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12563196
- ↑ 5.0 5.1 Journal Watch 23(22):174, 2003 Sprouse LR II et al Comparison of abdominal aortic aneurysm diameter measurements obtained with ultrasound and computed tomography: Is there a difference? J Vasc Surg 38:466, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12947257
- ↑ 6.0 6.1 Journal Watch 24(1):6, 2004 Aston HA 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, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12443589
- ↑ 7.0 7.1 Multicentre Aneurysm Screening Group Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial. BMJ 325:1135, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12433761
- ↑ Journal Watch 24(19):149, 2004 Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004 Sep 4;364(9437):843-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15351191
- ↑ 9.0 9.1 9.2 Norman PE, Jamrozik K, Lawrence-Brown MM, Le MT, Spencer CA, Tuohy RJ, Parsons RW, Dickinson JA. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ. 2004 Nov 27;329(7477):1259. Epub 2004 Nov 15. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15545293 <Internet> http://bmj.bmjjournals.com/cgi/content/full/329/7477/1259
- ↑ 10.0 10.1 Journal Watch 25(5):40, 2005 Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005 Feb 1;142(3):203-11. Review. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15684209 <Internet> http://www.ahrq.gov/clinic/3rduspstf/aaascr/aaarev.htm
U.S. Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med. 2005 Feb 1;142(3):198-202. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15684208 <Internet> http://www.ahrq.gov/clinic/3rduspstf/aaascr/aaars.htm
Summaries for patients. Screening for abdominal aortic aneurysm: recommendations from the U.S. Preventive Services Task Force. Ann Intern Med. 2005 Feb 1;142(3):I52. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15684202 - ↑ 11.0 11.1 Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ. 2005 Apr 2;330(7494):750. Epub 2005 Mar 9. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15757960 <Internet> http://bmj.bmjjournals.com/cgi/content/full/330/7494/750
- ↑ 12.0 12.1 Hackam DG et al, Angiotensin-converting enzyme inhibitors and aortic rupture: A population-based case control study. Lancet 2006, 368:659 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16920471
- ↑ Lederle FA et al, The aneurysm detection and management study screening program. Arch Intern Med 2000, 160:1425 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10826454
Lederle FA et al, Yield of repeated screening for abdominal aortic aneurysm after a 4-year interval Arch Intern Med 2000, 160:1117 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10789604
Urbonavicius S et al, Predecitors of post-operative mortality following treatment for non-ruptured abdominal aortic aneurysm, Current Controlled Trials in Cardiovascular Medicine 2005, 6:14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16146566 - ↑ 14.0 14.1 14.2 Schermerhorn ML et al Endovascular vs open repair of abdominal aortic anuerysms in the Medicare population. N Engl J Med 2008, 358:464 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18234751
- ↑ 15.0 15.1 Kim LG, P Scott RA, Ashton HA, Thompson SG; Multicentre Aneurysm Screening Study Group. A sustained mortality benefit from screening for abdominal aortic aneurysm. Ann Intern Med. 2007 May 15;146(10):699-706. Erratum in: Ann Intern Med. 2007 Aug 7;147(3):216. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17502630
Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med. 2007 May 15;146(10):735-41. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17502634 - ↑ 16.0 16.1 Lederle FA et al. for the Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial. JAMA 2009 Oct 14; 302:1535. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19826022
- ↑ 17.0 17.1 17.2 United Kingdom EVAR Trial Investigators Endovascular versus Open Repair of Abdominal Aortic Aneurysm N Engl J Med. 2010 Apr 30. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20382983 <Internet> http://content.nejm.org/cgi/content/full/NEJMoa0909305
United Kingdom EVAR Trial Investigators Endovascular Repair of Aortic Aneurysm in Patients Physically Ineligible for Open Repair N Engl J Med. 2010 Apr 30. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20382982 <Internet> http://content.nejm.org/cgi/content/full/NEJMoa0911056
The EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): Randomised controlled trial. Lancet 2005 Jun 25; 365:2179-86. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15978925
The 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 Jun 25; 365:2187-92. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15978926 - ↑ 18.0 18.1 Ouriel K et al. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg 2010 May; 51:1081. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20304589
- ↑ 19.0 19.1 De Bruin JL et al. for the DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362:1881 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20484396
Jackson RS et al. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA 2012 Apr 18; 307:1621 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22511690 - ↑ 20.0 20.1 20.2 Duncan JL et al. Long term outcomes in men screened for abdominal aortic aneurysm: Prospective cohort study. BMJ 2012 May 4; 344:e2958 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22563092
- ↑ 21.0 21.1 Sogaard R et al Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: evaluation of a hypothetical cohort using a decision analytical model BMJ 2012;345:e4276 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22767630 <Internet> http://www.bmj.com/content/345/bmj.e4276
- ↑ 22.0 22.1 Sogaard R et al. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: Evaluation of a hypothetical cohort using a decision analytical model. BMJ 2012 Jul 5; 345:e4276 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22767630
- ↑ 23.0 23.1 Lederle FA et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med 2012 Nov 22; 367:1988. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23171095 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1207481
Beckman JA. Is the Dream of EVAR Over? N Engl J Med. 2012 Nov 22; 367:2041-2043 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23171101 - ↑ 24.0 24.1 Thompson SG, Ashton HA, Gao L et al Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ. 2009 Jun 24;338:b2307. doi:http://dx.doi.org/ 10.1136/bmj.b2307. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19553269
- ↑ The RESCAN Collaborators. Surveillance intervals for small abdominal aortic aneurysms: A meta-analysis. JAMA 2013 Feb 27; 309:806. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23443444
- ↑ Baxter BT, Terrin MC, Dalman RL. Medical management of small abdominal aortic aneurysms. Circulation. 2008 Apr 8;117(14):1883-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18391122
- ↑ 27.0 27.1 Ferguson CD, Clancy P, Bourke B et al Association of statin prescription with small abdominal aortic aneurysm progression. Am Heart J. 2010 Feb;159(2):307-13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20152231
- ↑ Ten Bosch JA, Teijink JA, Willigendael EM, Prins MH. Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients. J Vasc Surg. 2010 Jul;52(1):13-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20471775
- ↑ 29.0 29.1 Reimerink JJ et al. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: A multicenter randomized controlled trial. Ann Surg 2013 Aug; 258:248 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23549424
- ↑ 30.0 30.1 Meijer CA et al. Doxycycline for stabilization of abdominal aortic aneurysms: A randomized trial. Ann Intern Med 2013 Dec 17; 159:815 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24490266 <Internet> http://annals.org/article.aspx?articleid=1789251
- ↑ 31.0 31.1 Rapsomaniki E et al Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. The Lancet, Volume 383, Issue 9932, pg 1899-1911, 31 May 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24881994 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960685-1/abstract#
- ↑ 32.0 32.1 32.2 32.3 32.4 32.5 32.6 32.7 U.S. Preventive Services Task Force (USPSTF) Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement. DRAFT. Summary of Recommendations and Evidence. http://www.uspreventiveservicestaskforce.org/draftrec.htm
Guirguis-Blake JM et al Ultrasonography Screening for Abdominal Aortic Aneurysms: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 28 January 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24473919 <Internet> http://annals.org/article.aspx?articleid=1817257
LeFevre ML on behalf of the U.S. Preventive Services Task Force Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 24 June 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24957320 <Internet> http://annals.org/article.aspx?articleid=1883339
US Preventive Services Task Force. Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA 2019 Dec 10; 322:2211. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31821437
Guirguis-Blake JM et al. Primary care screening for abdominal aortic aneurysm: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2019 Dec 10; 322:2219. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31821436
Freischlag JA. Updated guidelines on screening for abdominal aortic aneurysm. JAMA 2019 Dec 10; 322:2177. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31821419 - ↑ 33.0 33.1 33.2 33.3 33.4 33.5 33.6 Kent KC Abdominal Aortic Aneurysms. N Engl J Med 2014; 371:2101-2108. November 27, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25427112 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1401430
- ↑ 34.0 34.1 Kent KC, Zwolak RM, Egorova NN, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 2010;52:539-548 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20630687
- ↑ Johansson M, Hansson A. Brodersen J Estimating overdiagnosis in screening for abdominal aortic aneurysm: could a change in smoking habits and lowered aortic diameter tip the balance of screening towards harm? BMJ 2015;350:h825 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25736421 <Internet> http://www.bmj.com/content/350/bmj.h825
- ↑ 36.0 36.1 Schermerhorn ML, Buck DB, O'Malley AJ et al Long-Term Outcomes of Abdominal Aortic Aneurysm in the Medicare Population. N Engl J Med. 2015 Jul 23;373(4):328-338. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26200979
- ↑ Buck DB, van Herwaarden JA, Schermerhorn ML, Moll FL Endovascular treatment of abdominal aortic aneurysms. Nat Rev Cardiol. 2014 Feb;11(2):112-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24343568
- ↑ Chaikof EL, Brewster DC, Dalman RL et al SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg. 2009 Oct;50(4):880-96 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19786241
- ↑ Handa N, Onohara T, Akaiwa K et al Early outcomes of endovascular aneurysm repair for abdominal aortic aneurysm: first preliminary report of national hospital organization network study in Japan. Ann Vasc Dis. 2011;4(3):218-24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23555456
- ↑ Hye RJ, Smith AE, Wong GH et al Leveraging the electronic medical record to implement an abdominal aortic aneurysm screening program. J Vasc Surg. 2014 Jun;59(6):1535-42. Epub 2014 Feb 5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24507825
- ↑ 41.0 41.1 41.2 41.3 Patel R, Sweeting MJ, Powell JT et al Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. Oct 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27743617 Free Article <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31135-7/fulltext
Herzeele IV, Vermassen F Selection, technique, and follow-up: Keys to success in EVAR. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27743616 Free Article <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31840-2/abstract - ↑ 42.0 42.1 Karthikesalingam A, Vidal-Diez A, Holt PJ et al. Thresholds for abdominal aortic aneurysm repair in England and the United States. N Engl J Med 2016 Nov 24; 375:2051. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27959727 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1600931
- ↑ 43.0 43.1 Abdominal Aortic Aneurysm. Society for Vascular Surgery In: Anello J, Feinberg B, Heinegg J et al New Clinical Practice Guidelines, February 2018. Medscape. February 07, 2018 https://reference.medscape.com/viewarticle/892328
Glovicki P, Lawrence PF, Forbes TL. Update of the Society for Vascular Surgery abdominal aortic aneurysm guidelines. J Vasc Surg. 2018 Jan;67(1):1. http://www.jvascsurg.org/article/S0741-5214(17)32369-8/fulltext - ↑ Hong H, Yang Y, Liu B, Cai W. Imaging of Abdominal Aortic Aneurysm: the present and the future. Curr Vasc Pharmacol. 2010 Nov;8(6):808-19. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20180767 Free PMC Article
- ↑ Elens M, Verhelst R Images in Clinical Medicine. A Pulsatile Abdominal Mass. N Engl J Med 2019; 380:e35. May 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31067376 https://www.nejm.org/doi/full/10.1056/NEJMicm1812453
- ↑ 46.0 46.1 Lederle FA, Kyriakides TC, Stroupe KT et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med 2019 May 30; 380:2126. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31141634 https://www.nejm.org/doi/10.1056/NEJMoa1715955
- ↑ 47.0 47.1 47.2 47.3 47.4 U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement. June 2019 Abdominal Aortic Aneurysm: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/abdominal-aortic-aneurysm-screening1
Draft Evidence Review. June 2019 Draft Evidence Review for Abdominal Aortic Aneurysm: Screening https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/abdominal-aortic-aneurysm-screening1 - ↑ 48.0 48.1 48.2 Olson SL, Wijesinha MA, Panthofer AM et al. Evaluating growth patterns of abdominal aortic aneurysm diameter with serial computed tomography surveillance. JAMA Surg 2021 Feb 17; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/33595625 https://jamanetwork.com/journals/jamasurgery/article-abstract/2776432
Kim GY, Corriere MA. Balancing watching vs waiting during imaging surveillance of small abdominal aortic aneurysms. JAMA Surg 2021 Feb 17; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33595617 https://jamanetwork.com/journals/jamasurgery/article-abstract/2776428 - ↑ 49.0 49.1 Columbo JA, Demsas F, Wanken ZJ et al. Stress testing before abdominal aortic aneurysm repair does not lead to a reduction in perioperative cardiac events. J Vasc Surg 2021 Sep; 74:694. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33684471 https://www.jvascsurg.org/article/S0741-5214(21)00335-9/fulltext
- ↑ 50.0 50.1 FDA Advisory Panel Recommendations on Lifelong Surveillance and Long-Term Postmarket Data Collection for Patients with AAA Endovascular Aortic Repair - Letter to Health Care Providers. Letters to Health Care Providers. Feb 28, 2022 https://www.fda.gov/medical-devices/letters-health-care-providers/fda-advisory-panel-recommendations-lifelong-surveillance-and-long-term-postmarket-data-collection
- ↑ 51.0 51.1 Klopf J et al. The prognostic impact of vascular calcification on abdominal aortic aneurysm progression. J Vasc Surg 2022 Jun; 75:1926 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34921970 Free article https://www.jvascsurg.org/article/S0741-5214(21)02598-2/fulltext
- ↑ Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67:2-77.e2. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29268916
- ↑ Isselbacher EM, Preventza O, Hamilton Black J 3rd et al 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Dec 13;146(24):e334-e482. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36322642 PMCID: PMC9876736 (available on 2023-12-13)
- ↑ 54.0 54.1 NEJM Knowledge+
- ↑ 55.0 55.1 DeHaven C et al. Octogenarians fare better under local anesthesia for elective endovascular aortic aneurysm repair. J Vasc Surg 2024 May; 79:1079. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38141740 https://www.jvascsurg.org/article/S0741-5214(23)02431-X/abstract