12-05-2012, 10:19 AM
Two large studies have confirmed the safety of semi-annual noninvasive surveillance, along with risk factor intervention, in asymptomatic patients with aneurysms 4.0 cm to 5.5 cm as compared with early surgery. Although β-blockers are often prescribed to slow progression, several randomized trials have failed to show a benefit of β-blockers on aneurysm enlargement. Case-controlled studies suggest that aneurysm rupture is less likely in patients treated with angiotensin-converting enzyme inhibitors, but this may be due to effects on matrix remodeling rather than hemodynamic effects.
Development and expansion of abdominal aortic aneurysms are related to inflammation and elaboration of proteases. In animal models, the use of statins or the immune modulators rapamycin or doxycycline appears to reduce formation and progression of aortic aneurysms. A small prospective human trial has demonstrated reduced rates of enlargement in patients treated with simvastatin. The effect of statins appears to be independent of cholesterol level, suggesting that an anti-inflammatory effect may be responsible.
Smoking is the strongest reversible association with abdominal aortic aneurysms, and smoking cessation is therefore recommended for prevention of aneurysms.
Development and expansion of abdominal aortic aneurysms are related to inflammation and elaboration of proteases. In animal models, the use of statins or the immune modulators rapamycin or doxycycline appears to reduce formation and progression of aortic aneurysms. A small prospective human trial has demonstrated reduced rates of enlargement in patients treated with simvastatin. The effect of statins appears to be independent of cholesterol level, suggesting that an anti-inflammatory effect may be responsible.
Smoking is the strongest reversible association with abdominal aortic aneurysms, and smoking cessation is therefore recommended for prevention of aneurysms.