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Pathology, natural history and treatment of abdominal aortic aneurysms

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Summary

With increasing age of the population and improvement of diagnostic tools, the incidence of abdominal aortic aneurysms (AAA) has been rising steadily. Despite an improvement in operative and interventional treatment options, AAA is the cause of death in 1–3% of men over 65 years of age in industrial countries, mostly due to rupture [1]. Therefore, routine screening for AAA by ultrasonography has been postulated in the past: a 60 year old man with an abdominal aortic diameter of less than 3 cm has a life-time risk of developing AAA close to zero. However, routine screening has not been found to be cost effective. Despite of the results of two well-designed studies, the limits of AAA qualifying the patient for surgery or intervention in contrast to conservative treatment is still a matter of debate. The present review article summarizes the current knowledge of the pathology, incidence, risks, natural course as well as symptoms and current treatment strategies of AAA on the basis of the recent literature.

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References

  1. Sakalihasan N, Limet R, Defawe OD (2005) Abdominal aortic aneurysm. Lancet 365:1577–1589

    Article  PubMed  CAS  Google Scholar 

  2. Multicentre Aneurysm Screening Study Group (2002) Multicentre aneurysm screening study (MASS): cost effectivenss analysis of screening for abdominal aortic aneurysm based on four year results from randomised controlled trial BMJ 325:1135–1138

  3. National Hospital Discharge Survey Data (2002) Hyattsville, Md: National Center for Health Statistics

  4. Isselbacher EM (2004) Diseases of the aorta. In: Braunwald E, Zipes DP, Libby P, Bonour RO (eds) Braunwald’s heart disease. Saunder Philadelphia, pp 1403–1404

  5. Liddington MI, Healther BP (1992) The relationship aortic diameter and body habitus. Eur J Vasc Surg 6:89–92

    Article  PubMed  CAS  Google Scholar 

  6. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC (1991) 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 13:452–458

    Article  PubMed  CAS  Google Scholar 

  7. Singh K, Bonaa KH, Jacobsen BK, Bjork L, Solberg S (2001) Prevalence and risk factors for abdominal aortic aneurysms in a population-based study: the Tromso Study. Am J Epidemiol 154:236–244

    Article  PubMed  CAS  Google Scholar 

  8. Liddington MI, Heather BP (1992) The relationship between aortic diameter and body habitus. Eur J Vasc Surg 6:89–92

    Article  PubMed  CAS  Google Scholar 

  9. Schumacher H, Eckstein HH, Kallinowski F, Allenberg JR (1996) Morphometry and classification in abdominal aortic aneurysms. J Endovasc Surg 4:39–44

    Article  Google Scholar 

  10. Jonasson L, Holm J, Skalli O, Bondjiers G, Hansson GK (1986) Regional accumulations of T cells, marcorphages, and smooth muscle cells in the human atherosclerotic plaque. Arteriosclerosis 6:131–138

    PubMed  CAS  Google Scholar 

  11. Herron GS, Unemori E, Wong M, Rapp JH, Hibbs MH, Stoney RJ (1991) Connective tissue proteinases and inhibitors in abdominal aortic aneurysms: involvement of the vasa vasorum in the pathogenesis of aortic aneurysms. Arterioscler Thromb 11:1667–1677

    PubMed  CAS  Google Scholar 

  12. Homes DR, Liao S, Parks WC, Thompson RW (1995) Medial neovascularization in abdominal aortic aneurysms: a histopathologic marker of aneurismal degeneration with pathophysiological implications. J Vasc Surg 21:761–771

    Article  Google Scholar 

  13. Shah PK (1997) Inflammation, metalloproteinases, and increased proteolysis: an emerging pathophysiological paradigm in aortic aneurysm. Circulation 96:2115–2117

    PubMed  CAS  Google Scholar 

  14. Curci JA, Lee JK, Thompson RW (2001) Pathogenesis of abdominal aortic aneurysm. In: Ernst CB, Stanley JC (eds) Current Therapy in Vascular Surgery. Elsevier, Philadelphia, pp 199–206

  15. MacSweeney STR, Powell JT, Greenhalgh RM (1994) Pathogenesis of abdominal aortic aneurysm. Br J Surg 81:935–941

    PubMed  CAS  Google Scholar 

  16. Van der Vliet J A, Boll APM (1997) Abdominal aortic aneurysm. Lancet 349:863–866

    Article  PubMed  CAS  Google Scholar 

  17. Satta J, Juvonen T, Haukipuro K, Juvonen M, Kairaluoma MI (1995) Increased turnover of collagen in abdominal aortic aneurysms, demonstrated by measuring the concentration of the aminoterminal propeptide of type III procollagen in peripheral and aortal blood samples. J Vasc Surg 22:155–160

    Article  PubMed  CAS  Google Scholar 

  18. Huffman MD, Curci JA, Moore G, Kerns DB, Starcher BC, Thompson RW (2000) Functional importance of connective tissue repair during the development of experimental abdominal aortic aneurysms. Surgery 128:429–438

    Article  PubMed  CAS  Google Scholar 

  19. Dobrin PB, Mrkvicka R (1994) Failure of elastin or collagen as possible critical connective tissue alterations underlying aneurysmal dilatation. Cardiovasc Surg 2:484–488

    PubMed  CAS  Google Scholar 

  20. Carrell TW, Burnand KG, Wells GM, Clements JM, Smith A (2000) Stromelysin- 1 (matrix metalloproteinase-3) and tissue inhibitor of metalloproteinase- 3 are overexpressed in the wall of abdominal aortic aneurysms. Circulation 105:477–482

    Article  Google Scholar 

  21. Defawe OD, Colige A, Lambert CA et al (2003) TIMP-2 and PAI-1 mRNA levels are lower in aneurysmal as compared to athero-occlusive abdominal aortas. Cardiovasc Res 60:205– 213

    Article  PubMed  CAS  Google Scholar 

  22. Rao SK, Reddy KV, Cohen JR (1996) Role of serine proteases in aneurysm development. Ann NY Acad Sci 800:131–137

    Article  PubMed  CAS  Google Scholar 

  23. Thompson RW, Parcs WC (1996) Role of matrix metalloproteinases in abdominal aortic aneurysms. Ann NY Acad Sci 800:157–174

    Article  PubMed  CAS  Google Scholar 

  24. Longo GM, Xiong W, Greiner TC, Zhao Y, Fiotti N, Baxter BT (2002) Matrix metalloproteinases 2 and 9 work in concert to produce aortic aneurysms. J Clin Invest 110:625–632

    Article  PubMed  CAS  Google Scholar 

  25. Shi G-P, Sukhova GK, Grubb A (1999) Cystatin C deficiency in human atherosclerosis and aortic aneurysms J Clin Invest 104:1191–1997

    Article  PubMed  CAS  Google Scholar 

  26. Zhao L, Moos PW, Gräbner R, Pedrono F, Fan J, Kaiser B, John N, Schmidt S, Spanbroek R, Lotzer K, Huang L, Cui J, Rader DJ, Evans JF, Hebnicht AJ, Funk CD (2004) The 5- lipoxygenase pathway promotes pathogenesis of hyperlipidemia-dependent aortic aneurysm. Nature 9:966–973

    Google Scholar 

  27. Lopez-Candales A, Holmes DR, Liao S, Scott MJ, Wickline SA, Thompson RW (1997) Decreased vascular smooth muscle cell density in medial degeneration of human abdominal aortic aneurysms. Am J Pathol 150:993–1007

    PubMed  CAS  Google Scholar 

  28. Allaire E, Muscatelli-Groux B, Mandet C et al (2002) Paracrine effect of vascular smooth muscle cells in the prevention of aortic aneurysm formation. J Vasc Surg 36:1018–1026

    Article  PubMed  Google Scholar 

  29. Vorp DA, Lee PC, Wang DH et al (2001) Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and walk weakening. J Vasc Surg 43:291–299

    Article  Google Scholar 

  30. Sakalihasan N, Delvenne P, Nusgens BV, Limet R, Lapiere CM (1996) Activated forms of MMP2 and MMP9 in abdominal aortic aneurysms. J Vasc Surg 24:127–133

    Article  PubMed  CAS  Google Scholar 

  31. Fontaine V, Jacob MP, Houard X et al (2002) Involvement of the mural thrombus as a site of protease release and activation in human aortic aneurysms. Am J Pathol 161:1701–1710

    PubMed  CAS  Google Scholar 

  32. Havanna KK, Eliason JL, Woodrum DT et al (2005) L-Selectin-mediated neutrophil recruitment in experimental rodent aneurysm formation. Circulation 112:241–247

    Article  CAS  Google Scholar 

  33. Jones K, Powell J, Brown L, Greenhalgh R, Jormsjo S, Eriksson P (2002) Influence of 4G/5G polymorphism in the plasminogen activator inhibitor-1 gene promotor on the incidence, growth and operative risk of abdominal aortic aneurysm. Eur. J Vasc Endovasc Surg 23:421–425

    Article  PubMed  CAS  Google Scholar 

  34. Boucher P, Gotthardt M, Li WP, Anderson RG, Herz J (2003) LRP: role in vascular wall integrity and protection from atherosclerosis. Science 300:329–332

    Article  PubMed  CAS  Google Scholar 

  35. Lederle, FA, Johnson GR, Wilson SE et al (2000) The aneurysm detection and mangement study screening program: validation cohort and final results. Arch Intern Med 160:1425–1430

    Article  PubMed  CAS  Google Scholar 

  36. Lindholdt JS, Vammen S, Juul S, Fasting H, Henneberg EW (2000) Optimal interval screening and surveillance of abdominal aortic aneurysms. Eur J Vasc Endovasc 20:369–373

    Google Scholar 

  37. Vardulaki KA, Walker NM, Day NE, Duffy W, Ashton HA, Scott RA (2000) Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm. Br J Surg 87:195–200

    Article  PubMed  CAS  Google Scholar 

  38. Pleumeekers HJCM, Hoes AW, van der Does E et al (1995) Aneurysms of the abdominal aorta in older adults; the Rotterdam study. Am J Epidemiol 142:1291–1299

    PubMed  CAS  Google Scholar 

  39. Simoni G, Pastorino C, Perrone R, Ardia A, Gianrossi R, Decian F (1995) Screening for abdominal aortic aneurysms and associated risk factors in a general population. Eur J Vasc Endovasc Surg 10:207–210

    Article  PubMed  CAS  Google Scholar 

  40. Lederle FA, Johnson GR, Wilson SE (1997) Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detections and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med 126(6):441–449

    PubMed  CAS  Google Scholar 

  41. Brown LC, Powell JT (1999) Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg 230:289–296; discussion 296–297

    Article  PubMed  CAS  Google Scholar 

  42. Blanchard JF, Armenian HK, Friesen PP (2000) Risk factors for abdominal aortic aneurysm: results of a casecontrol study. Am J Epidemiol 151:575–583

    PubMed  CAS  Google Scholar 

  43. Lindholt JS, Heegaard NH, Vammen S, Fasting H, Henneberg EW, Heickendorff L (2001) Smoking, but not lipids, lipoprotein(a) and antibodies against oxidised LDL, is correlated to the expansion of abdominal aortic aneuysms. Eur J Vasc Endovasc Surg 21:51–56

    Article  PubMed  CAS  Google Scholar 

  44. Wilmink TBM, Quick CRG, Day NE (1999) The association between cigarette smoking and abdominal aortic aneurysms. J Vasc Surg 30:1099–1105

    Article  PubMed  CAS  Google Scholar 

  45. Davies MJ (1998) Aortic aneurysm formation: lessons from human studies and experimental models. Circulation 98:193

    PubMed  CAS  Google Scholar 

  46. Vardulaki KA, Prevost TC, Walker NM, Day NE, Wilmink AB, Quick CR, Ashton HA, Scott RA (1998) Growth rate and risk of rupture of abdominal aoric aneurysms. Br J Surg 85:1674–1680

    Article  PubMed  CAS  Google Scholar 

  47. Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT (2004) Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 110:16–21

    Article  PubMed  Google Scholar 

  48. MacSweeney STR, Ellis M, Worrell PC, Greenhalgh RM, Powell JT (1994) Smoking and growth rate of small abdominal aortic aneurysms. Lancet 344:651–652

    Article  PubMed  CAS  Google Scholar 

  49. Moran CS, McCann M, Karan M, Norman P, Ketheesan N, Golledge J (2005) Association of osteoprotegerin with human abdominal aortic aneurysm progression. Circulation 111(23):3119–3125

    Article  PubMed  CAS  Google Scholar 

  50. Newman AB, Shemanski L, Manolio TA et al (1999) Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol 19:538–545

    PubMed  CAS  Google Scholar 

  51. Gacko M, Chyczewski L (1997) Activity and localization of cathepsin B, D, and G in aortic aneurysm. Int Surg 82(4):398–402

    PubMed  CAS  Google Scholar 

  52. Portik-Dobos V, Anstat MP, Hutchinson J et al (2002) Evidence for a matrix metalloproteinase induction/activation system in arterial vasculature and decreased synthesis and activity in diabetes. Diabetes 51:3036–3068

    Google Scholar 

  53. Mehard WB, Heiken JP, Sicard GA (1994) High-attenuating crescent in abdominal aortic aneurysm wall at CT: a sign of acute or impending rupture. Radiology 192:359–362

    PubMed  CAS  Google Scholar 

  54. Siegel CL, Cohan RH, Korobkin M, Alpern MB, Courneya DL, Leder RA (1994) Abdominal aortic aneurysm morphology: CT features in patients with ruptured and nonruptured aneurysms. AJR Am J Roentgenol 163:1123–1129

    PubMed  CAS  Google Scholar 

  55. Arita T, Matsunaga N, Takano K et al (1997) Abdominal aortic aneurysm: rupture associated with the high-attenuating crescent sign. Radiology 204:765–768

    PubMed  CAS  Google Scholar 

  56. Sakalihasan N, Van Damme H, Gomez P et al (2002) Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA). Eur J Vasc Endovasc Surg 23:431–436

    Article  PubMed  CAS  Google Scholar 

  57. Elzouki AN, Ryden Ahlgren A, Lanne T, Sonesson B, Eriksson S (1999) Is there a relationship between abdominal aortic aneurysms and alpha1- antitrypsin deficiency (PiZ)? Eur J Vasc Endovasc Surg 17:149–154

    Article  PubMed  CAS  Google Scholar 

  58. Limet R, Sakalihasan N, Albert A (1991) Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms. J Vasc Surg 14):540–548

    Article  PubMed  CAS  Google Scholar 

  59. Muluk SC, Gertler JP, Brewster DC et al (1994) Presentations and patterns of aortic aneuryms in young patients. J Vasc Surg 20:880

    PubMed  CAS  Google Scholar 

  60. Kiell CS, Ernst CB (1993) Advances in the management of abdominal aortic aneurysms. Dv Surg 26:73

    CAS  Google Scholar 

  61. Tang T, Wai-Leng C, Munday I, Gaunt M (2005) Ruptured abdominal aortic aneurysm. Lancet 365(9461):818

    PubMed  Google Scholar 

  62. Abrurahma AF, Woodruff BA, Stuart SP, Lucente FC, Boland JP (1991) Early diagnosis and survival of ruptured abdominal aoric aneurysms. Am J Emerg Med 9(2):118–121

    Article  Google Scholar 

  63. Parry DJ, Waterworth A, Kessel D, Robertson I, Berridge DC, Scott DJ (2001) Endovascular repair of an inflammatory abdominal aortic aneurysm complicated by aortoduodenal fistulation with an unusual presentation. J Vasc Surg 33:874–879

    Article  PubMed  CAS  Google Scholar 

  64. Kane JM, Meyer KA, Kozoll DD (1955) An anatomical approach to the problem of massive gastrointestinal hemorrhag. AMA Arch Surg 70:570–582

    PubMed  CAS  Google Scholar 

  65. Hirst AE Jr, Affeldt J (1951) Abdominal aortic aneurysm with rupture into the duodenum; a report of eight cases. Gastroenterol 17:504–514

    Google Scholar 

  66. Lemos DW, Raffetto JD, Moore TC, Menzoian JO (2003) Primary aortoduodenal fistula: a case report and review of the literature. J Vasc Surg 37:686–689

    Article  PubMed  Google Scholar 

  67. Davis PM, Gloviczki P, Cherry KJ Jr et al (1998) Aorto-caval and ilio-iliac arteriovenous fistulae. Am J Surg 176:115–118

    Article  PubMed  CAS  Google Scholar 

  68. Lederle FA, Walker JM, Reinke DB (1988) Selective screening for abdominal aortic aneuryms with physical examination and ultrasound. Arch Intern Med 148:1753–1756

    Article  PubMed  CAS  Google Scholar 

  69. Beede SD, Ballard DJ, James EM, Ilstrup DM, Hallet JW Jr (1990) Positive predictive value of clinical suspicion of abdominal aortic aneurysm. Implications for efficient use of abdominal ultrasonography. Arch Intern Med 150(3):549–551

    Article  PubMed  CAS  Google Scholar 

  70. Lindholt JS, Vammen S, Juul S, Henneberg EW, Fasting H (1999) The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 17(6):472–775

    Article  PubMed  CAS  Google Scholar 

  71. Crow P, Shaw E, Earnshaw JJ, Poskitt KR, Whyman MR, Heather BP (2001) A single normal ultrasonographic scan at age 65 years rules out significant aneurysm disease for life in men. Br J Surg 88:941–944

    Article  PubMed  CAS  Google Scholar 

  72. Scott RAP, Vardulaki KA, Walker NM, Day NE, Duffy W, Ashton HA (2001) The longterm benefits of a single scan for abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Eur J Vasc Endovasc Surg 21:535–540

    Article  PubMed  CAS  Google Scholar 

  73. Frydman G, Walker PJ, Summers K et al (2003) The value of screening in siblings of patients with abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 26:396–400

    Article  PubMed  CAS  Google Scholar 

  74. Silence J, Lupu F, Collen D, Lijnen HR (2001) Persistence of atherosclerotic plaque but reduced aneurysm formation in mice with stromelysin-1 (MMP-3) gene inactivation. Atheroscler Thromb Vasc Biol 1440–1445

  75. Powell JT, Greenhalgh RM (2003) Clinical practice. Small abdominal aortic aneurysms. N Engl J Med 348(19):1895–1901

    Article  PubMed  Google Scholar 

  76. The UK Small Aneurysm Trial Participants (1998) Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 352:1649–1655

    Article  Google Scholar 

  77. The United Kingdom Small Aneurysm Trial Participants (2002) Longterm outcomes of immediate repair compared with surveillance for small abdominal aortic aneurysm. N Engl J Med 346:1445–1452

    Article  Google Scholar 

  78. Ashton HA, Buxton MJ, Day NE et al (2002) The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality on men: a randomised controlled trial. Lancet 360:1531–1539

    Article  PubMed  CAS  Google Scholar 

  79. Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499

    Article  PubMed  CAS  Google Scholar 

  80. Prinssen M, Verhoeven EL, Buth J et al (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618

    Article  PubMed  CAS  Google Scholar 

  81. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operativ mortality results: randomied controlled trial. Lancet 364:843–848

    Article  PubMed  CAS  Google Scholar 

  82. Hallet JW Jr, Marshall DM, Petterson TM et al (1997) Graft-related complications after abdominal artic aneurysm repair: reassurance from a 36- year population-based experience. J Vasc Surg 25:277–284; discussion 285–286

    Article  Google Scholar 

  83. Johnston KW (1994) Nonruptured abdominal aortic aneurysm: six-year follow-up results from the mulicenter prospective Canadian aneurysm study. J Vasc Surg 20:163–170

    PubMed  CAS  Google Scholar 

  84. Lederle FA, Wilson ES, Johnson GR et al (2002) Immediate repair compared with surveillance of small aortic abdominal aneurysms. N Engl J Med 346:1437–1444

    Article  PubMed  Google Scholar 

  85. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365:2179–2186

    Article  Google Scholar 

  86. Blankensteijn JD, de Jong SECA, Prinsson M, van der Ham AC, Buth J, van Sterkenburg SMM, Verhagen HJM, Buskens E, Grobbee DE for the Dutch Randomised Endovascular Aneurysm Management (DREAM) (2005) Trial Group N Engl J Med 352:2398–2405

    Article  PubMed  CAS  Google Scholar 

  87. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants (2005) Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 365:2187–2192

    Article  Google Scholar 

  88. Curci JA, Petrinec D, Liao S, Golub LM, Thompson RW (1998) Pharmacological suppression of experimental abdominal aortic aneurysms: a comparison of doxycycline and four chemically modified tetracyclines. J Vasc Surg 28:1082–1093

    Article  PubMed  CAS  Google Scholar 

  89. Bigatel DA, Elmore JR, Carey DJ, Cizmeci- Smith G, Franklin DP, Youkey JR (1999) The matrix metalloproteinase inhibitor BB-94 limits expansion of experimental abdominal aortic aneurysms. J Vasc Surg 29:130–138; discussion 138–139

    Article  PubMed  CAS  Google Scholar 

  90. Moore G, Liao S, Curci JA et al (1999) Suppression of experimental abdominal aortic aneurysms by systemic treatment with a hydroxamatebased matrix metalloproteinase inhibitor (RS 132908). J Vasc Surg 29:522–532

    Article  PubMed  CAS  Google Scholar 

  91. Takemoto M, Liao JK (2001) Pleiotropic effects of 3-hydroxy-3-methylglutary coenzyme A reductase inhibitors. Arterioscler Thromb Vasc Biol 21:1712–1719

    PubMed  CAS  Google Scholar 

  92. Crisby M, Nordin-Fredriksson G, Sha PK, Yano J, Zhu J, Nilsson J (2001) Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization. Circulation 103:926–933

    PubMed  CAS  Google Scholar 

  93. Sposito AC, Chapman MJ (2002) Statin therapy in acute coronary syndromes; mechanistic insight into clinical benefit. Arterioscer Thromb Vasc Biol 22:1524–1534

    Article  CAS  Google Scholar 

  94. Kwak B, Mulhaupt F, Myit S, Mach F (2000) Statins as a newly recognized type of immunomodulator. Nat Med 6:1399–1402

    Article  PubMed  CAS  Google Scholar 

  95. Kertai MD, Boersma E, Westerhout CM et al (2004) Association between long-term statin use and mortality after successful abdominal aortic aneurysm surgery. Am J Med 116:96–103

    Article  PubMed  CAS  Google Scholar 

  96. Nagashima H, Aoka Y, Sakomura Y et al (2002) A 3-hydroxy-3-methylglutaryl coenzyme. A reductase inhibitor, cerivastatin, suppresses production of matrix metalloproteinase-9 in human abdominal aortic aneurysm wall. J Vasc Surg 26:158–163

    Article  Google Scholar 

  97. Gadowski GR, Pilcher DB, Ricci MA (1994) Abdominal aortic aneurysm expansion rate: effect of size and beta-adrenergic blockade. J Vasc Surg 19:727–731

    PubMed  CAS  Google Scholar 

  98. Slaiby JM, Ricci MA, Gadowski GR, Hendley ED, Pilcher DB (1994) Expansion of aortic aneurysms is reduced by propanolol in a hypertensive rat model. J Vasc Surg 20:178–183

    PubMed  CAS  Google Scholar 

  99. Nilsson J, Hansson GK, Shah PK (2005) Immunomodulation of atherosclerosis: implications for vaccine development. Arterioscler Thromb Vasc Biol 25:18–28

    PubMed  CAS  Google Scholar 

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  1. Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    A. R. Zankl, U. Krumsdorf, H. A. Katus, L. Jahn &  Christiane P. Tiefenbacher

  2. Department of Vascular Surgery, Ruprechts-Karls University Heidelberg, Im Neuenheimer Feld 410 and 110, 69120, Heidelberg, Germany

    H. Schumacher

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  1. A. R. Zankl
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Zankl, A.R., Schumacher, H., Krumsdorf, U. et al. Pathology, natural history and treatment of abdominal aortic aneurysms. Clin Res Cardiol 96, 140–151 (2007). https://doi.org/10.1007/s00392-007-0472-5

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