Aortic aneurysms

The prevalence of aortic aneurysm is increasing; it is responsible for 1–2% of all deaths in men aged over 65 years in the Western world. The majority of aortic aneurysms affect the abdominal portion of the aorta. The disease most commonly represents a multifactorial degenerative process involving both genetic and environmental risk factors. It is characterized pathologically by a reduction in elastic lamellae within the aortic wall. The natural history of the condition is one of progressive enlargement with an associated increase risk of aneurysm rupture. Although aneurysm rupture remains a catastrophic event, with an overall mortality of approximately 80%, the majority of patients are asymptomatic. Asymptomatic aneurysms are usually diagnosed as an incidental finding and management relies on an assessment of the risks of future aneurysm rupture weighed against the risks associated with elective surgical repair. Aneurysm repair may be accomplished by traditional open surgery or minimally invasive endovascular repair. Although the latter confers a short- and medium-term survival advantage in selected patients, long-term follow-up data are still awaited.