Detection, management, and prospects for the medical treatment of small abdominal aortic aneurysms
Detection, management, and prospects for the medical treatment of small abdominal aortic aneurysms
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DOI：
10.1161/01.atv.0000106016.13624.4a
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发表时间：
2004-02-01
影响因子：
8.7
通讯作者：
Brady, AR
中科院分区：
文献类型：
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作者：
Powell, JT;Brady, AR
直径达5.5 cm的小型腹主动脉瘤非常常见。超声检查是检测这些动脉瘤并对其进行监测的最具成本效益的方法，因为动脉瘤的自然病程是持续扩张的。扩张速率在0.25至0.35 cm/y的范围内，并且在当前吸烟者中最快。通过对扩张率的研究，有可能制定出监测间隔的指导方针。尽管来自随机试验的证据表明，早期、开放、择期手术治疗小动脉瘤不能挽救生命，但当动脉瘤直径超过5.5 cm时，建议开放或血管内手术。为了防止小动脉瘤达到5.5 cm的阈值，需要根据潜在的病理过程（蛋白水解和炎症）设计新的治疗方法，将扩张率降低>50%。任何拟议的治疗方法，包括他汀类药物，都需要在临床试验中进行测试。
Small abdominal aortic aneurysms, up to 5.5 cm in diameter, are very common. Ultrasonography is the most cost-effective method of detecting these aneurysms and keeping them under surveillance, because the natural history is 1 of continued expansion. The expansion rate is in the range 0.25 to 0.35 cm/y and is fastest in current smokers. From a study of expansion rates, it has been possible to formulate guidelines for the intervals at which surveillance should occur. Although the evidence from randomized trials indicates that early, open, elective surgery for small aneurysms does not save lives, when aneurysms exceed 5.5 cm in diameter, either open or endovascular surgery is recommended. To prevent small aneurysms reaching the 5.5-cm threshold, new treatments to reduce the expansion rate by >50% need to be designed, based on the underlying pathologic processes: proteolysis and inflammation. Any proposed treatments, including statins, will need to be tested in clinical trials.