Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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

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


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 differ 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'.)


Epidemiology — The prevalence of abdominal aortic aneurysm (AAA) is 4 to 8 percent in screening studies, affecting predominantly males [6-9]. 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 [10]. 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 [11]. 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 [12-14].

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. As an example, in one study, among men aged 65 to 74 years, the incidence was 55 per 100,000 person-years, increasing to 112 per 100,000 person-years for men aged 75 to 85 years, and further increasing to 298 per 100,000 person-years for those older than 85 [19].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 28, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991; 13:452.
  2. Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg 2009; 50:880.
  3. Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011; 41 Suppl 1:S1.
  4. Deaths, percent of total deaths, and death rates for the 15 leading causes of death in 5-year age groups, by race, and sex: United States, 2013. www.cdc.gov/nchs/data/dvs/lcwk1_2013.pdf. Accessed January 29,2016.
  5. Lu H, Rateri DL, Bruemmer D, et al. Novel mechanisms of abdominal aortic aneurysms. Curr Atheroscler Rep 2012; 14:402.
  6. Ashton HA, Buxton MJ, Day NE, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 2002; 360:1531.
  7. Norman PE, Jamrozik K, Lawrence-Brown MM, et al. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ 2004; 329:1259.
  8. Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ 2005; 330:750.
  9. Ashton HA, Gao L, Kim LG, et al. Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms. Br J Surg 2007; 94:696.
  10. Von Allmen RS, Powell JT. The management of ruptured abdominal aortic aneurysms: screening for abdominal aortic aneurysm and incidence of rupture. J Cardiovasc Surg (Torino) 2012; 53:69.
  11. Percent Distribution of the Projected Population by Sex and Selected Age Groups for the United States: 2015 to 2060. www.census.gov/population/projections/data/national/2014/summarytables.html (Accessed on January 29, 2016).
  12. Grøndal N, Søgaard R, Lindholt JS. Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial). Br J Surg 2015; 102:902.
  13. Benson RA, Poole R, Murray S, et al. Screening results from a large United Kingdom abdominal aortic aneurysm screening center in the context of optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme protocols. J Vasc Surg 2016; 63:301.
  14. Svensjö S, Björck M, Gürtelschmid M, et al. Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation 2011; 124:1118.
  15. Forsdahl SH, Singh K, Solberg S, Jacobsen BK. Risk factors for abdominal aortic aneurysms: a 7-year prospective study: the Tromsø Study, 1994-2001. Circulation 2009; 119:2202.
  16. Vardulaki KA, Prevost TC, Walker NM, et al. Incidence among men of asymptomatic abdominal aortic aneurysms: estimates from 500 screen detected cases. J Med Screen 1999; 6:50.
  17. Lederle FA, Johnson GR, Wilson SE, et al. Yield of repeated screening for abdominal aortic aneurysm after a 4-year interval. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160:1117.
  18. Wilmink AB, Hubbard CS, Day NE, Quick CR. The incidence of small abdominal aortic aneurysms and the change in normal infrarenal aortic diameter: implications for screening. Eur J Vasc Endovasc Surg 2001; 21:165.
  19. Howard DP, Banerjee A, Fairhead JF, et al. Population-Based Study of Incidence of Acute Abdominal Aortic Aneurysms With Projected Impact of Screening Strategy. J Am Heart Assoc 2015; 4:e001926.
  20. Stackelberg O, Wolk A, Eliasson K, et al. Lifestyle and Risk of Screening-Detected Abdominal Aortic Aneurysm in Men. J Am Heart Assoc 2017; 6.
  21. Scott RA, Bridgewater SG, Ashton HA. Randomized clinical trial of screening for abdominal aortic aneurysm in women. Br J Surg 2002; 89:283.
  22. Ulug P, Powell JT, Sweeting MJ, et al. Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women. Br J Surg 2016; 103:1097.
  23. Rogers IS, Massaro JM, Truong QA, et al. Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol 2013; 111:1510.
  24. Salem MK, Rayt HS, Hussey G, et al. Should Asian men be included in abdominal aortic aneurysm screening programmes? Eur J Vasc Endovasc Surg 2009; 38:748.
  25. Lederle FA, Johnson GR, Wilson SE, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160:1425.
  26. Kent KC, Zwolak RM, Egorova NN, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 2010; 52:539.
  27. Clifton MA. Familial abdominal aortic aneurysms. Br J Surg 1977; 64:765.
  28. Blanchard JF, Armenian HK, Friesen PP. Risk factors for abdominal aortic aneurysm: results of a case-control study. Am J Epidemiol 2000; 151:575.
  29. Larsson E, Granath F, Swedenborg J, Hultgren R. A population-based case-control study of the familial risk of abdominal aortic aneurysm. J Vasc Surg 2009; 49:47.
  30. Roddy SP. Family history of aortic aneurysm is an independent risk factor for more rapid growth of small abdominal aortic aneurysms in Japan. J Vasc Surg 2015; 61:566.
  31. Joergensen TM, Houlind K, Green A, Lindholt JS. Abdominal aortic diameter is increased in males with a family history of abdominal aortic aneurysms: results from the Danish VIVA-trial. Eur J Vasc Endovasc Surg 2014; 48:669.
  32. Shibamura H, Olson JM, van Vlijmen-Van Keulen C, et al. Genome scan for familial abdominal aortic aneurysm using sex and family history as covariates suggests genetic heterogeneity and identifies linkage to chromosome 19q13. Circulation 2004; 109:2103.
  33. Bertoli-Avella AM, Gillis E, Morisaki H, et al. Mutations in a TGF-β ligand, TGFB3, cause syndromic aortic aneurysms and dissections. J Am Coll Cardiol 2015; 65:1324.
  34. Lederle FA, Nelson DB, Joseph AM. Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review. J Vasc Surg 2003; 38:329.
  35. Wong DR, Willett WC, Rimm EB. Smoking, hypertension, alcohol consumption, and risk of abdominal aortic aneurysm in men. Am J Epidemiol 2007; 165:838.
  36. Whitehouse WM Jr, Wakefield TW, Graham LM, et al. Limb-threatening potential of arteriosclerotic popliteal artery aneurysms. Surgery 1983; 93:694.
  37. Graham LM, Zelenock GB, Whitehouse WM Jr, et al. Clinical significance of arteriosclerotic femoral artery aneurysms. Arch Surg 1980; 115:502.
  38. Larsson E, Vishnevskaya L, Kalin B, et al. High frequency of thoracic aneurysms in patients with abdominal aortic aneurysms. Ann Surg 2011; 253:180.
  39. Chaer RA, Vasoncelos R, Marone LK, et al. Synchronous and metachronous thoracic aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg 2012; 56:1261.
  40. Ball BZ, Jiang B, Mehndiratta P, et al. Screening individuals with intracranial aneurysms for abdominal aortic aneurysms is cost-effective based on estimated coprevalence. J Vasc Surg 2016; 64:811.
  41. Kim DH, Van Ginhoven G, Milewicz DM. Familial aggregation of both aortic and cerebral aneurysms: evidence for a common genetic basis in a subset of families. Neurosurgery 2005; 56:655.
  42. Norrgård O, Angqvist KA, Fodstad H, et al. Co-existence of abdominal aortic aneurysms and intracranial aneurysms. Acta Neurochir (Wien) 1987; 87:34.
  43. Hernesniemi JA, Vänni V, Hakala T. The prevalence of abdominal aortic aneurysm is consistently high among patients with coronary artery disease. J Vasc Surg 2015; 62:232.
  44. van de Luijtgaarden KM, Bastos Gonçalves F, Hoeks SE, et al. Lower atherosclerotic burden in familial abdominal aortic aneurysm. J Vasc Surg 2014; 59:589.
  45. Alcorn HG, Wolfson SK Jr, Sutton-Tyrrell K, et al. Risk factors for abdominal aortic aneurysms in older adults enrolled in The Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 1996; 16:963.
  46. Iribarren C, Darbinian JA, Go AS, et al. Traditional and novel risk factors for clinically diagnosed abdominal aortic aneurysm: the Kaiser multiphasic health checkup cohort study. Ann Epidemiol 2007; 17:669.
  47. Cronin O, Liu D, Bradshaw B, et al. Visceral adiposity is not associated with abdominal aortic aneurysm presence and growth. Vasc Med 2014; 19:272.
  48. Golledge J, Clancy P, Jamrozik K, Norman PE. Obesity, adipokines, and abdominal aortic aneurysm: Health in Men study. Circulation 2007; 116:2275.
  49. Long A, Bui HT, Barbe C, et al. Prevalence of abdominal aortic aneurysm and large infrarenal aorta in patients with acute coronary syndrome and proven coronary stenosis: a prospective monocenter study. Ann Vasc Surg 2010; 24:602.
  50. Stackelberg O, Björck M, Larsson SC, et al. Alcohol consumption, specific alcoholic beverages, and abdominal aortic aneurysm. Circulation 2014; 130:646.
  51. Stackelberg O, Björck M, Larsson SC, et al. Fruit and vegetable consumption with risk of abdominal aortic aneurysm. Circulation 2013; 128:795.
  52. Behr-Rasmussen C, Grøndal N, Bramsen MB, et al. Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study. Eur J Vasc Endovasc Surg 2014; 48:301.
  53. Shantikumar S, Ajjan R, Porter KE, Scott DJ. Diabetes and the abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2010; 39:200.
  54. Lederle FA, Noorbaloochi S, Nugent S, et al. Multicentre study of abdominal aortic aneurysm measurement and enlargement. Br J Surg 2015; 102:1480.
  55. Pafili K, Gouni-Berthold I, Papanas N, Mikhailidis DP. Abdominal aortic aneurysms and diabetes mellitus. J Diabetes Complications 2015; 29:1330.
  56. Tilson MD, Toset A, Tyrie L. Chicken embryology of human aneurysm-resistant arteries. Matrix Biol 2006; 25:134.
  57. Davidson JM, Hill KE, Mason ML, Giro MG. Longitudinal gradients of collagen and elastin gene expression in the porcine aorta. J Biol Chem 1985; 260:1901.
  58. Gadson PF Jr, Dalton ML, Patterson E, et al. Differential response of mesoderm- and neural crest-derived smooth muscle to TGF-beta1: regulation of c-myb and alpha1 (I) procollagen genes. Exp Cell Res 1997; 230:169.
  59. Jones JA, Spinale FG, Ikonomidis JS. Transforming growth factor-beta signaling in thoracic aortic aneurysm development: a paradox in pathogenesis. J Vasc Res 2009; 46:119.
  60. Dobrin PB, Baker WH, Gley WC. Elastolytic and collagenolytic studies of arteries. Implications for the mechanical properties of aneurysms. Arch Surg 1984; 119:405.
  61. Wolinsky H, Glagov S. Nature of species differences in the medial distribution of aortic vasa vasorum in mammals. Circ Res 1967; 20:409.
  62. McDonald DA. Regional pulse-wave velocity in the arterial tree. J Appl Physiol 1968; 24:73.
  63. Boussel L, Rayz V, McCulloch C, et al. Aneurysm growth occurs at region of low wall shear stress: patient-specific correlation of hemodynamics and growth in a longitudinal study. Stroke 2008; 39:2997.
  64. Tronc F, Mallat Z, Lehoux S, et al. Role of matrix metalloproteinases in blood flow-induced arterial enlargement: interaction with NO. Arterioscler Thromb Vasc Biol 2000; 20:E120.
  65. Groenendijk BC, Hierck BP, Vrolijk J, et al. Changes in shear stress-related gene expression after experimentally altered venous return in the chicken embryo. Circ Res 2005; 96:1291.
  66. Vanderlaan PA, Reardon CA. Thematic review series: the immune system and atherogenesis. The unusual suspects:an overview of the minor leukocyte populations in atherosclerosis. J Lipid Res 2005; 46:829.
  67. Ihara M, Urata H, Kinoshita A, et al. Increased chymase-dependent angiotensin II formation in human atherosclerotic aorta. Hypertension 1999; 33:1399.
  68. Raffort J, Lareyre F, Clément M, et al. Monocytes and macrophages in abdominal aortic aneurysm. Nat Rev Cardiol 2017; 14:457.
  69. Sharma AK, Lu G, Jester A, et al. Experimental abdominal aortic aneurysm formation is mediated by IL-17 and attenuated by mesenchymal stem cell treatment. Circulation 2012; 126:S38.
  70. Koch AE, Haines GK, Rizzo RJ, et al. Human abdominal aortic aneurysms. Immunophenotypic analysis suggesting an immune-mediated response. Am J Pathol 1990; 137:1199.
  71. Schönbeck U, Sukhova GK, Gerdes N, Libby P. T(H)2 predominant immune responses prevail in human abdominal aortic aneurysm. Am J Pathol 2002; 161:499.
  72. Yoshimoto T, Paul WE. CD4pos, NK1.1pos T cells promptly produce interleukin 4 in response to in vivo challenge with anti-CD3. J Exp Med 1994; 179:1285.
  73. Shimizu K, Shichiri M, Libby P, et al. Th2-predominant inflammation and blockade of IFN-gamma signaling induce aneurysms in allografted aortas. J Clin Invest 2004; 114:300.
  74. Miller FJ Jr, Sharp WJ, Fang X, et al. Oxidative stress in human abdominal aortic aneurysms: a potential mediator of aneurysmal remodeling. Arterioscler Thromb Vasc Biol 2002; 22:560.
  75. Thomas M, Gavrila D, McCormick ML, et al. Deletion of p47phox attenuates angiotensin II-induced abdominal aortic aneurysm formation in apolipoprotein E-deficient mice. Circulation 2006; 114:404.
  76. Jalalzadeh H, Indrakusuma R, Planken RN, et al. Inflammation as a Predictor of Abdominal Aortic Aneurysm Growth and Rupture: A Systematic Review of Imaging Biomarkers. Eur J Vasc Endovasc Surg 2016; 52:333.
  77. McBride OM, Joshi NV, Robson JM, et al. Positron Emission Tomography and Magnetic Resonance Imaging of Cellular Inflammation in Patients with Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2016; 51:518.
  78. MA3RS Study Investigators. Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair. Circulation 2017; 136:787.
  79. Watanabe N, Arase H, Kurasawa K, et al. Th1 and Th2 subsets equally undergo Fas-dependent and -independent activation-induced cell death. Eur J Immunol 1997; 27:1858.
  80. Zubiaga AM, Munoz E, Huber BT. IL-4 and IL-2 selectively rescue Th cell subsets from glucocorticoid-induced apoptosis. J Immunol 1992; 149:107.
  81. Werb Z, Banda MJ, Jones PA. Degradation of connective tissue matrices by macrophages. I. Proteolysis of elastin, glycoproteins, and collagen by proteinases isolated from macrophages. J Exp Med 1980; 152:1340.
  82. Henderson EL, Geng YJ, Sukhova GK, et al. Death of smooth muscle cells and expression of mediators of apoptosis by T lymphocytes in human abdominal aortic aneurysms. Circulation 1999; 99:96.
  83. Shimizu K, Mitchell RN, Libby P. Inflammation and cellular immune responses in abdominal aortic aneurysms. Arterioscler Thromb Vasc Biol 2006; 26:987.
  84. McPhee JT, Hill JS, Eslami MH. The impact of gender on presentation, therapy, and mortality of abdominal aortic aneurysm in the United States, 2001-2004. J Vasc Surg 2007; 45:891.
  85. Acosta S, Ogren M, Bengtsson H, et al. Increasing incidence of ruptured abdominal aortic aneurysm: a population-based study. J Vasc Surg 2006; 44:237.
  86. Bhak RH, Wininger M, Johnson GR, et al. Factors associated with small abdominal aortic aneurysm expansion rate. JAMA Surg 2015; 150:44.
  87. Lederle FA, Johnson GR, Wilson SE, et al. Relationship of age, gender, race, and body size to infrarenal aortic diameter. The Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Investigators. J Vasc Surg 1997; 26:595.
  88. Brady AR, Thompson SG, Fowkes FG, et al. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 2004; 110:16.
  89. Limet R, Sakalihassan N, Albert A. Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms. J Vasc Surg 1991; 14:540.
  90. Mani K, Wanhainen A, Lundkvist J, Lindström D. Cost-effectiveness of intensive smoking cessation therapy among patients with small abdominal aortic aneurysms. J Vasc Surg 2011; 54:628.
  91. Sweeting MJ, Thompson SG, Brown LC, et al. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg 2012; 99:655.
  92. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg 1999; 230:289.
  93. Darling RC, Messina CR, Brewster DC, Ottinger LW. Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circulation 1977; 56:II161.
  94. Fillinger MF, Raghavan ML, Marra SP, et al. In vivo analysis of mechanical wall stress and abdominal aortic aneurysm rupture risk. J Vasc Surg 2002; 36:589.
  95. Kleinstreuer C, Li Z. Analysis and computer program for rupture-risk prediction of abdominal aortic aneurysms. Biomed Eng Online 2006; 5:19.
  96. Gasser TC, Nchimi A, Swedenborg J, et al. A novel strategy to translate the biomechanical rupture risk of abdominal aortic aneurysms to their equivalent diameter risk: method and retrospective validation. Eur J Vasc Endovasc Surg 2014; 47:288.
  97. Vantrimpont PJ, van Dalen BM, van Riemsdijk-van Overbeeke IC, et al. Abdominal aortic aneurysms after heart transplantation. J Heart Lung Transplant 2004; 23:171.
  98. Cron DC, Coleman DM, Sheetz KH, et al. Aneurysms in abdominal organ transplant recipients. J Vasc Surg 2014; 59:594.
  99. Cronenwett JL, Murphy TF, Zelenock GB, et al. Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms. Surgery 1985; 98:472.
  100. Smart CJ, Fisher RK. Influence of sex on expansion rate of abdominal aortic aneurysms (Br J Surg 2007; 94: 310-314). Br J Surg 2007; 94:1041.
  101. Lo RC, Lu B, Fokkema MT, et al. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg 2014; 59:1209.
  102. Vande Geest JP, Dillavou ED, Di Martino ES, et al. Gender-related differences in the tensile strength of abdominal aortic aneurysm. Ann N Y Acad Sci 2006; 1085:400.
  103. Fillinger MF, Marra SP, Raghavan ML, Kennedy FE. Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. J Vasc Surg 2003; 37:724.
  104. Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg 2006; 81:169.
  105. Fillinger MF, Racusin J, Baker RK, et al. Anatomic characteristics of ruptured abdominal aortic aneurysm on conventional CT scans: Implications for rupture risk. J Vasc Surg 2004; 39:1243.
  106. Durham SJ, Steed DL, Moosa HH, et al. Probability of rupture of an abdominal aortic aneurysm after an unrelated operative procedure: a prospective study. J Vasc Surg 1991; 13:248.
  107. Paty PS, Darling RC 3rd, Chang BB, et al. Repair of large abdominal aortic aneurysm should be performed early after coronary artery bypass surgery. J Vasc Surg 2000; 31:253.
  108. Salomaa V, Riley W, Kark JD, et al. Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC Study. Atherosclerosis Risk in Communities Study. Circulation 1995; 91:1432.
  109. Takagi H, Umemoto T, ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Coronary artery disease and abdominal aortic aneurysm growth. Vasc Med 2016; 21:199.