Department of Mechanical Engineering, Tufts University, Medford, MA, USA.
Department of Surgery, Tufts Medical Center, Boston, MA, USA.
Adv Exp Med Biol. 2018;1097:157-179. doi: 10.1007/978-3-319-96445-4_8.
Abdominal aortic aneurysms (AAAs) are permanent, local expansions of the abdominal segment of the aorta that can potentially be fatal if progressing to rupture. AAAs are rarely found in patients under age 60, but are more common in older age groups, occurring in 2-3% of the whole population. Their rupture produces up to 14,000 deaths annually in the United States alone. Because aneurysmal rupture is a mechanical phenomenon, in recent years there has been a major effort among researchers to investigate the biologic and mechanical processes surrounding AAA progression and rupture. In addition to the basic science importance of understanding AAA pathophysiology, much of this research has been directed toward the development of accurate clinical criteria for assessing the risk of rupture on a patient-by-patient basis. This review first summarizes degenerative changes of the aorta wall associated with AAA pathogenesis. Current understanding of hemodynamics, transport, and wall mechanics in AAAs is then described, and open questions in aneurysm research are discussed along with potential directions in which further understanding could lead to improved clinical evaluation and management decision processes.
腹主动脉瘤（AAA）是腹主动脉局部的永久性扩张，如果进展到破裂，可能是致命的。AAA 在 60 岁以下的患者中很少见，但在年龄较大的人群中更为常见，占总人口的 2-3%。仅在美国，每年因动脉瘤破裂而导致的死亡人数就达 14000 人。由于动脉瘤破裂是一种机械现象，近年来，研究人员在 AAA 进展和破裂的生物学和力学过程方面进行了大量研究。除了理解 AAA 病理生理学的基础科学重要性之外，这项研究的很大一部分还针对开发评估患者个体破裂风险的准确临床标准。这篇综述首先总结了与 AAA 发病机制相关的主动脉壁退行性变化。然后描述了目前对 AAA 中的血液动力学、转运和壁力学的理解，并讨论了动脉瘤研究中的开放性问题，以及进一步理解可能导致改善临床评估和管理决策过程的潜在方向。
