Carino Davide, Sarac Timur P, Ziganshin Bulat A, Elefteriades John A
Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut.
Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Int J Angiol. 2018 Jun;27(2):58-80. doi: 10.1055/s-0038-1657771. Epub 2018 May 29.
Abdominal aortic aneurysm (AAA) is defined as a permanent dilatation of the abdominal aorta that exceeds 3 cm. Most AAAs arise in the portion of abdominal aorta distal to the renal arteries and are defined as infrarenal. Most AAAs are totally asymptomatic until catastrophic rupture. The strongest predictor of AAA rupture is the diameter. Surgery is indicated to prevent rupture when the risk of rupture exceeds the risk of surgery. In this review, we aim to analyze this disease comprehensively, starting from an epidemiological perspective, exploring etiology and pathophysiology, and concluding with surgical controversies. We will pursue these goals by addressing eight specific questions regarding AAA: (1) Is the incidence of AAA increasing? (2) Are ultrasound screening programs for AAA effective? (3) What causes AAA: Genes versus environment? (4) Animal models: Are they really relevant? (5) What pathophysiology leads to AAA? (6) Indications for AAA surgery: Are surgeons over-eager to operate? (7) Elective AAA repair: Open or endovascular? (8) Emergency AAA repair: Open or endovascular?
腹主动脉瘤（AAA）被定义为腹主动脉的永久性扩张，直径超过3厘米。大多数腹主动脉瘤发生在肾动脉远端的腹主动脉部分，被定义为肾下型。大多数腹主动脉瘤在灾难性破裂前完全没有症状。腹主动脉瘤破裂的最强预测因素是直径。当破裂风险超过手术风险时，建议进行手术以预防破裂。在本综述中，我们旨在从流行病学角度出发，全面分析这种疾病，探索病因和病理生理学，并以手术争议作为总结。我们将通过回答关于腹主动脉瘤的八个具体问题来实现这些目标：（1）腹主动脉瘤的发病率是否在增加？（2）腹主动脉瘤的超声筛查项目是否有效？（3）腹主动脉瘤的病因是什么：基因还是环境？（4）动物模型：它们真的相关吗？（5）导致腹主动脉瘤的病理生理学是什么？（6）腹主动脉瘤手术的指征：外科医生是否急于手术？（7）择期腹主动脉瘤修复：开放手术还是血管腔内修复？（8）急诊腹主动脉瘤修复：开放手术还是血管腔内修复？
