Rutherford's 072: Aortoiliac Aneurysms: Evaluation, Decision Making, and Medical Management скачать в хорошем качестве

Rutherford's 072: Aortoiliac Aneurysms: Evaluation, Decision Making, and Medical Management

#AAAJ #Aneurysm #VascularSurgery #EndovascularRepair #EVAR #RuptureRisk #Smoking #Screening #Rutherford #Pathophysiology This summary focuses on aortoiliac aneurysms, primarily abdominal aortic aneurysms (AAAs), based on Rutherford's Vascular Surgery. An aneurysm is a 1.5 times increase in artery diameter, typically over 3 cm for the infra-renal aorta. Treatment evolved from ancient methods to open surgery and the revolutionary endovascular repair (EVAR), now frequently preferred for planned and emergency AAA cases. A true aneurysm involves all three wall layers, unlike pseudo-aneurysms (contained rupture). AAA prevalence in the U.S. is about 1.4% in older adults. Age is the strongest risk factor, significantly increasing prevalence with each decade. Male sex and Caucasian race also increase risk. Smoking is the largest modifiable risk factor, with risk tied to dose and duration. Family history increases risk by about 20%. AAAs often occur with iliac, popliteal, or femoral aneurysms. Rupture is the main threat, strongly correlated with size. Risk rises significantly over 5 cm. Female patients have a three-fold higher rupture risk than men at the same aneurysm size. Smoking cessation and blood pressure control lower this risk. The aneurysm wall weakens due to inflammation and enzymes (MMPs), a process influenced by intramural clot (ILT). Genetics play a major role, with high heritability. Most AAAs are asymptomatic. Diagnosis involves ultrasound for screening and surveillance, and CT angiography for detailed planning. A one-time ultrasound screen is recommended for men and women aged 65-75 who have ever smoked, and for first-degree relatives. Surveillance intervals depend on aneurysm size. Despite animal study promise, drugs like statins, ACE inhibitors, beta blockers, and doxycycline have not consistently shown to slow human AAA growth in trials. Management prioritizes risk factor control. Intervention (open or endovascular) is typically indicated electively at 5.5 cm for men and 5.0 cm for women due to size-related rupture risk differences. Symptomatic or ruptured aneurysms require urgent/emergency repair. Decision-making between open and endovascular repair considers patient health, anatomy, and durability, often using risk calculators. Research is ongoing into biomarkers, genetics, and effective medical therapies.