Center for Vascular Research, University of Maryland, United States of America.
Center for Vascular Research, University of Maryland, United States of America; University of Maryland, United States of America; Endovascular Surgery, University of Maryland Medical Center, United States of America; Baltimore VA Medical Center, United States of America.
Prog Cardiovasc Dis. 2021 Mar-Apr;65:34-43. doi: 10.1016/j.pcad.2021.03.009. Epub 2021 Apr 5.
Abdominal aortic aneurysms (AAA) are prevalent among older adults and can cause significant morbidity and mortality if not addressed in a timely fashion. Their etiology remains the topic of continued investigation. Known causes include trauma, infection, and inflammatory disorders. Risk factors include cigarette smoking, advanced age, dyslipidemia, hypertension, and coronary artery disease. The pathophysiology of the disease is related to an initial arterial insult causing a cascade of inflammation and extracellular matrix protein breakdown by proteinases leading to arterial wall weakening. When identified early, aneurysms must be monitored for size, growth rate, and other factors which could increase the risk of rupture. Factors predisposing to rupture include size, active smoking, rate of growth, aberrant biomechanical properties of the aneurysmal sac, and female sex. Medical management includes the control of risk factors that may prevent growth, stabilize the aneurysm, and prevent rupture. Surgical management prevents rupture of high risk aneurysms, most commonly predicted by size. Less frequently, surgical management is required when the aneurysm has ruptured. Surgery involves a multidisciplinary approach to evaluate the patient's risk profile and to develop an operative plan involving either an endovascular or an open surgical repair. The patient must be carefully monitored post-operatively for complications and, in the case of endovascular repairs, for endoleaks. AAA management has evolved rapidly in recent years. Technical and technological advances have transformed the diagnosis and treatment of this disease.
腹主动脉瘤（AAA）在老年人中较为常见，如果不能及时治疗，可能会导致严重的发病率和死亡率。其病因仍然是持续研究的课题。已知的病因包括外伤、感染和炎症性疾病。危险因素包括吸烟、高龄、血脂异常、高血压和冠心病。该疾病的病理生理学与初始动脉损伤有关，导致炎症级联反应和蛋白酶引起的细胞外基质蛋白分解，从而导致动脉壁减弱。早期发现的动脉瘤必须监测其大小、生长速度和其他可能增加破裂风险的因素。易发生破裂的因素包括大小、主动吸烟、生长速度、动脉瘤囊的异常生物力学特性和女性性别。医学治疗包括控制可能导致生长、稳定动脉瘤和预防破裂的危险因素。手术治疗可预防高危动脉瘤破裂，最常见的预测因素是大小。在动脉瘤破裂的情况下，较少需要手术治疗。手术涉及多学科方法来评估患者的风险状况，并制定涉及血管内或开放手术修复的手术计划。术后必须仔细监测患者的并发症，对于血管内修复，还必须监测内漏。近年来，AAA 的管理迅速发展。技术和技术的进步改变了这种疾病的诊断和治疗。
