Abdominal aortic aneurysm medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Aarti Narayan, M.B.B.S [3]

Overview

Risk factor modification including smoking cessation, management of hypertension, and lipid lowering are essential in reducing the risk of development and the rate of progression of abdominal aortic aneurysms.

Medical Therapy

Management

Risk factor modification
- Smoking cessation
  - Contributes to formation and rupture of aneurysm
  - Individuals with family history of abdominal aortic aneurysms should be advised to stop smoking
ACEI, beta blockers and statins:
- Risk factors for atherosclerosis like hypertension and hyperlipidemia should be controlled
- Their use may also prolong survival by preventing progression of cardiac and cerebrovascular disease
- Statins may reduce mortality in patients who have undergone an abdominal aortic aneurysm repair ^[1]
- Use of beta blockers may have a beneficial effect on expansion of aneurysm from its effect on reduction of blood pressure. It is used routinely in patients with abdominal aortic aneurysm followed non-operatively ^[2].
Aspirin
- The beneficial effects of aspirin on prevention of CAD and PAD outweighs its risk of causing bleeding
Antibiotics for possible chlamydia infection
Assess for coronary, carotid and peripheral vascular disease
Surveillance:
- 4 to 5.4 cm - monitor every 6 to 12 months
- 3 to 4 cm - monitor every 2 to 3 years

Chronic pharmacotherapies

Antimetalloproteases such as doxycycline and roxithromycin may halt aneurysm expansion
Similarly, non-steriod anti inflammatory drugs have shown to be beneficial in small studies
Beta blockers have numerous benefits in patients with cardiovascular disease
- Reduce aortic complications in patients with Marfan syndrome
- Slow progression of AAAs in hypertensive patients
- In the absence of other indications for beta blockers, the evidence is insufficient to recommend using them routinely for the sole purpose of slowing atherosclerotic aneurysm growth

References

↑ Kalyanasundaram A, Elmore JR, Manazer JR; et al. (2006). "Simvastatin suppresses experimental aortic aneurysm expansion". Journal of Vascular Surgery. 43 (1): 117–24. doi:10.1016/j.jvs.2005.08.007. PMID 16414398. Unknown parameter |month= ignored (help)
↑ Hirsch AT, Haskal ZJ, Hertzer NR; et al. (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Unknown parameter |month= ignored (help)

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[pmid16414398-1] Kalyanasundaram A, Elmore JR, Manazer JR; et al. (2006). "Simvastatin suppresses experimental aortic aneurysm expansion". Journal of Vascular Surgery. 43 (1): 117–24. doi:10.1016/j.jvs.2005.08.007. PMID 16414398. Unknown parameter |month= ignored (help)

[pmid16549646-2] Hirsch AT, Haskal ZJ, Hertzer NR; et al. (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Unknown parameter |month= ignored (help)

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