Abdominal aortic aneurysm medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Aarti Narayan, M.B.B.S [3]; Vishnu Vardhan Serla M.B.B.S. [4] Ramyar Ghandriz MD[5] Hibatullah Abdul Aleem, M.B.B.S[6]
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. These measures reduce cardiovascular mortality, which is the leading cause of death in patients under AAA surveillance, and may attenuate aneurysm growth. Medical therapy must be coupled with appropriate surveillance imaging, optimization of surgical risk, and timely referral for repair when size or growth rate thresholds are met.
Risk Factor Modification
- Smoking Cessation:[1]
- Risk factors for atherosclerosis development and progression such as hypertension and Hyperlipidemia should be controlled.[2]
Medical Therapy
Antihypertensive Therapy
- Antihypertensives are recommended for patients with abdominal aortic aneurysm and hypertension.[2]
- Slow progression of AAAs in hypertensive patients.
- Beta-adrenergic blocking agents are indicated perioperatively (in the absence of contraindications) to reduce the risk of adverse cardiac events and mortality in patients with coronary artery disease undergoing surgical AAA repair.[2]
- Patients with Marfan syndrome should be treated with a maximally tolerated β-blocker or an angiotensin receptor blocker to reduce the rate of aortic dilation.[5]
Statins
Aspirin
- The use of low-dose aspirin is considered reasonable for patients with atherosclerotic abdominal aortic aneurysm.[6]
- The beneficial effects of aspirin on prevention of CAD and PAD among patients at low to intermediate risk of bleeding likely outweighs its bleeding risk.
2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines (DO NOT EDIT)[7][1][2]
Treatment of AAA with Statins [7]
| Class I |
| 1. In patients with AAA and evidence of aortic atherosclerosis, statin therapy at moderate or high intensity is recommended. (Level of Evidence: B-NR) |
| Class IIb |
| 1. In patients with AAA but no evidence of atherosclerosis, statin therapy may be considered . (Level of Evidence: C-LD) |
Blood Pressure Control [7]
| Class I |
| 1. Blood pressure control to <130/80 mmHg is recommended in patients with AAA and hypertension. (Level of Evidence: C-LD) |
Smoking Cessation[7]
| Class I |
| 1. Smoking cessation is recommended for all patients with AAA. (Level of Evidence: B-NR) |
Perioperative Beta-Blockade[2]
| Class I |
| 1.Perioperative administration of beta-adrenergic blocking agents, in the absence of contraindications, is indicated to reduce the risk of adverse cardiac events and mortality in patients with coronary artery disease undergoing surgical repair of atherosclerotic aortic aneurysms.(Level of Evidence: A) |
| Class IIb |
| 1.Beta-adrenergic blocking agents may be considered to reduce the rate of aneurysm expansion in patients with aortic aneurysms. (Level of Evidence: B) |
Medical Therapy for Acute Aortic Syndromes[7]
| Class I |
| 1. All patients with acute aortic syndromes should receive blood pressure–lowering therapy with intravenous (IV) β-blockers as first-line agents and IV vasodilators as second-line agents.(Level of Evidence: B-NR) |
Surveillance Imaging for Abdominal Aortic Aneurysm[8]
- Every 3 years in patients with AAA diameter 3.0-3.9 cm
- Annually in men with AAA diameter 4.0-4.9 cm or women with AAA diameter 4.0-4.4 cm
- Every 6 months in men with AAA diameter ≥5.0 cm or women with AAA diameter ≥4.5 cm.
References
- ↑ 1.0 1.1 Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJ, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BM, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SW, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK (February 2024). "Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms". Eur J Vasc Endovasc Surg. 67 (2): 192–331. doi:10.1016/j.ejvs.2023.11.002. PMID 38307694 Check
|pmid=value (help). - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JG, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ (November 2023). "2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines". J Thorac Cardiovasc Surg. 166 (5): e182–e331. doi:10.1016/j.jtcvs.2023.04.023. PMID 37389507 Check
|pmid=value (help). - ↑ MacSweeney ST, Ellis M, Worrell PC, Greenhalgh RM, Powell JT (September 1994). "Smoking and growth rate of small abdominal aortic aneurysms". Lancet. 344 (8923): 651–2. doi:10.1016/s0140-6736(94)92087-7. PMID 7915350.
- ↑ Gouveia E Melo R, Melo F, Fernández Prendes C, Magalhães T, Fernandes E Fernandes R, Mendes Pedro L, Caldeira D (January 2026). "Effect of smoking cessation on abdominal aortic aneurysm growth: a systematic review and network meta-analysis". Int Angiol. doi:10.23736/S0392-9590.25.05487-2. PMID 41543285 Check
|pmid=value (help). Vancouver style error: missing comma (help) - ↑ Pitcher A, Spata E, Emberson J, Davies K, Halls H, Holland L, Wilson K, Reith C, Child AH, Clayton T, Dodd M, Flather M, Jin XY, Sandor G, Groenink M, Mulder B, De Backer J, Evangelista A, Forteza A, Teixido-Turà G, Boileau C, Jondeau G, Milleron O, Lacro RV, Sleeper LA, Chiu HH, Wu MH, Neubauer S, Watkins H, Dietz H, Baigent C (September 2022). "Angiotensin receptor blockers and β blockers in Marfan syndrome: an individual patient data meta-analysis of randomised trials". Lancet. 400 (10355): 822–831. doi:10.1016/S0140-6736(22)01534-3. PMC 7613630 Check
|pmc=value (help). PMID 36049495 Check|pmid=value (help). - ↑ Hariri E, Matta M, Layoun H, Badwan O, Braghieri L, Owens AP, Burton R, Bhandari R, Mix D, Bartholomew J, Schumick D, Elbadawi A, Kapadia S, Hazen SL, Svensson LG, Cameron SJ (December 2023). "Antiplatelet Therapy, Abdominal Aortic Aneurysm Progression, and Clinical Outcomes". JAMA Netw Open. 6 (12): e2347296. doi:10.1001/jamanetworkopen.2023.47296. PMC 10716735 Check
|pmc=value (help). PMID 38085542 Check|pmid=value (help). - ↑ 7.0 7.1 7.2 7.3 7.4 Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Alric P, Canaud L, Janotta M, Raithel D, Malina W, Resch T, Eckstein HH, Ockert S, Larzon T, Carlsson F, Schumacher H, Classen S, Schaub P, Lammer J, Lönn L, Clough RE, Rampoldi V, Trimarchi S, Fabiani JN, Böckler D, Kotelis D, Böckler D, Kotelis D, von Tenng-Kobligk H, Mangialardi N, Ronchey S, Dialetto G, Matoussevitch V (September 2014). "Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial". Eur J Vasc Endovasc Surg. 48 (3): 285–91. doi:10.1016/j.ejvs.2014.05.012. PMID 24962744.
- ↑ "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines - PubMed".