And in its management, several studies have shown that the newer endovascular repair is much preferred over the conventional open surgery for practical and scientific reasons.
Without trying to look like a meta-analysis, I have searched the World Wide Web for articles on this disease entity. And my purpose in doing this is to evaluate the advantages and disadvantages of the methods for its diagnosis, its indications for surgery, methods of surgery, and general outcome after treatment.
An aneurysm in its most simple definition is a localized dilatation of an artery involving an increase in its diameter of at least 50 percent in comparison to its original normal diameter. Anatomically, it often represents a weakness in the wall of the artery at any given segment of the aorta. It is noted that there is an increasing incidence of aortic aneurysms lately. Hence, there is also a trend in seeking better methods for diagnosing and treating this pathology. Without trying to look like a meta-analysis, I did an on-line systematic Medline and PubMed search and then reviewed the retrieved articles on the diagnosis, pathogenesis, treatment and current management of aortic aneurysms. ...
Just for the purpose of discussion in this paper, I shall classify aortic aneurysms based on their location, since these may appear elsewhere. If the dilation appears on the aortic root they are called aortic root aneurysm. If the dilatation is found in the thoracic aorta, they are called thoracic aortic aneurysms. Aneurysms are also classified based on their location in the thoracic segments of the thoracic aorta; hence we may have an ascending, an arch aneurysm or a descending thoracic aneurysm. Aneurysms found after the descending segment is termed abdominal aortic aneurysm.
In the physical examination for suspected aortic aneurysm, the only maneuver of demonstrated value is abdominal palpation to detect abnormal widening of the aortic pulsation. Palpation appears to be safe and has not been reported to precipitate rupture. The diagnosis of aortic aneurysms is confirmed based on findings with ultrasonography or computerized tomography. There is limited data to suggest that abdominal obesity decreases the sensitivity of palpation. Abdominal palpation specifically directed at measuring aortic width has moderate sensitivity for detecting an aneurysm that would be large enough to be referred for surgery but cannot be relied on to exclude aortic aneurysm, especially if rupture is a possibility.
The role of genetic factors influencing familial aggregation of aortic aneurysms has also been reviewed. Aortic aneurysms, particularly the thoracic ones, and those in association with multiplex pedigrees represent a new risk factor for aneurysm growth. Pedigree analysis suggests genetic heterogeneity. The primary mode of inheritance seems to be autosomal dominant, but X-linked dominant and recessive modes are also evident.
In the past,