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Epidemiology, risk factors, pathogenesis and natural history of abdominal aortic aneurysm

Author
Jayer Chung, MD, MSc
Section Editors
Emile R Mohler III, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

An abdominal aortic aneurysm (AAA) is a focal dilation (figure 1) 50 percent greater than the normal diameter of the aorta. The abdominal aorta is the most common site of true arterial aneurysm affecting predominantly the segment of aorta below the renal arteries (infrarenal aorta) [1]. Well-defined risk factors are associated with the development of AAA and include advanced age, male gender, Caucasian race, a positive family history, smoking, the presence of other large vessel aneurysms, and atherosclerosis [2,3]. The Centers for Disease Control ranked AAA as the 15th leading cause of mortality in the United States in 2013 in adults between 60 and 64 years of age [4].

AAAs progressively dilate over time. While expansion rates vary, large aneurysms generally expand at a faster rate than small aneurysms [2,3]. Mechanisms for the development, expansion, and rupture of AAA have been validated in animal models. However, the relative contribution of these in humans is unclear [5]. The main risk factors associated with expansion and rupture of AAA are somewhat different from those that contribute to the development of AAA, and include large aneurysm diameter, rapid expansion, smoking, hypertension, elevated peak wall stress, a history of cardiac or renal transplant, decreased forced expiratory volume, and female gender [2,3]. While there is significant overlap, the epidemiology, risk factors, pathogenesis, and natural history of the development of AAA differs somewhat from the natural history of expansion and rupture, and will therefore be discussed separately.

The epidemiology, risk factors, pathogenesis, and natural history of AAA are reviewed here. The diagnosis, management, and treatment of AAA are discussed in detail elsewhere. Definitions of aneurysms by their location relative to the visceral vessels, involvement of the vessel layer walls, morphology (saccular versus fusiform), and diameter (small versus large) are described in detail elsewhere. (See "Clinical features and diagnosis of abdominal aortic aneurysm", section on 'Aneurysm definition and anatomy' and "Management of asymptomatic abdominal aortic aneurysm", section on 'Introduction'.)

DEVELOPMENT OF AAA

Epidemiology — Previous ultrasound screening studies show that among males aged between 65 and 80 years, the prevalence of abdominal aortic aneurysm (AAA) is 4 to 8 percent [6-9]. AAA prevalence in 65- to 80-year-old women is four to six times lower compared with their male counterparts, at approximately 1.3 percent [10]. However, AAAs found on screening are generally small; those measuring ≥5.5 cm or greater are found in only 0.4 to 0.6 percent of those screened [11]. Because the incidence of AAA rises sharply in individuals over 60 years of age, the future prevalence of AAA could increase substantially in association with the aging population [12]. On the other hand, some suggest that a reduction in the prevalence of smoking could have the opposite effect (figure 2), with several studies citing a lower prevalence of AAA in 65- to 80-year-old Caucasian adults [13,14].  

The annual incidence of new AAA diagnoses is approximately 0.4 to 0.67 percent in Western populations. This equates to 2.5 to 6.5 aneurysms per 1000 person-years [15-18]. Age significantly impacts the incidence, however, with steep increases in the incidence to 55 per 100,000 person-years in the 65- to 74-year-old age group. The incidence increases further to 112 per 100,000 person-years for those aged 75 to 85 years. Those aged greater than 85 years have an incidence at 298 per 100,000 person-years [19].

                            

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Literature review current through: Nov 2016. | This topic last updated: Mon Jul 18 00:00:00 GMT+00:00 2016.
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