Abdominal aortic aneurysms
Abdominal aortic aneurysms
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DOI：
10.1038/s41572-018-0030-7
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发表时间：
2018-10-18
影响因子：
81.5
通讯作者：
Hultgren, Rebecka
中科院分区：
文献类型：
--
作者：
Sakalihasani, Natzi;Michel, Jean-Baptiste;Hultgren, Rebecka
腹主动脉瘤（AAA）是肾下主动脉的局部扩张。AAA是一种多因素疾病，遗传和环境因素起一定作用;吸烟、男性和阳性家族史是最重要的风险因素，AAA在65岁以上的男性中最常见。AAA由主动脉壁结构的变化引起，包括由于血管平滑肌细胞的损失和细胞外基质的降解而导致的中膜和外膜变薄。如果作用在壁上的血压的机械应力超过壁强度，AAA破裂，导致危及生命的腹腔内出血-AAA破裂患者的死亡率为65- 85%。尽管任何尺寸的AAA都可能破裂，但破裂的风险随着直径的增加而增加。完整的AAA通常是无症状的，在没有实施超声检查筛查计划的情况下，大多数病例都是偶然诊断的。现代功能成像技术（PET，CT和MRI）可能有助于评估破裂风险。应考虑采用开放手术或主动脉腔内修复术（EVAR）进行选择性AAA修复，以预防AAA破裂，尽管与两种技术相关的发病率和死亡率仍然不可忽略。
An abdominal aortic aneurysm (AAA) is a localized dilatation of the infrarenal aorta. AAA is a multifactorial disease, and genetic and environmental factors play a part; smoking, male sex and a positive family history are the most important risk factors, and AAA is most common in men >65 years of age. AAA results from changes in the aortic wall structure, including thinning of the media and adventitia due to the loss of vascular smooth muscle cells and degradation of the extracellular matrix. If the mechanical stress of the blood pressure acting on the wall exceeds the wall strength, the AAA ruptures, causing life-threatening intra-abdominal haemorrhage - the mortality for patients with ruptured AAA is 65-85%. Although AAAs of any size can rupture, the risk of rupture increases with diameter. Intact AAAs are typically asymptomatic, and in settings where screening programmes with ultrasonography are not implemented, most cases are diagnosed incidentally. Modern functional imaging techniques (PET, CT and MRI) may help to assess rupture risk. Elective repair of AAA with open surgery or endovascular aortic repair (EVAR) should be considered to prevent AAA rupture, although the morbidity and mortality associated with both techniques remain non-negligible.