Abdominal aortic aneurysms – a topic of enlarging interest

Publisher Summary The cause of most aneurysms is as much an enigma as ever; however, the usual explanation is of degeneration of collagen and elastin in the aging arterial wall. A genetic defect is occasionally responsible for defective collagen production. It is unknown as to why the infrarenal aorta is principally affected; explanations for the initial damage to the arterial wall include hypertension, damage to vasa vasorum, and the resonance of standing waves at the aortic bifurcation. The accuracy of diagnosis of tender aneurysms has been improved by imaging techniques. Screening programs are disclosing asymptomatic small aneurysms that are a source of anxiety to both patients and vascular surgeons. Repeated scanning is seen by many as procrastination in the face of the inevitable, with a clean surgical strike being preferred. Intervention certainly helps patients with large aneurysms and may confer a survival advantage in those with aneurysms of 4–5 cm external diameter or less.