Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2011, vol. 20, nr 2, March-April, p. 221–225

Publication type: review article

Language: English

Potential Indicators of the Degree of Abdominal Aortic Aneurysm Development in Rupture Risk Estimation

Potencjalne wskaźniki stopnia rozwoju tętniaka aorty brzusznej w ocenie prawdopodobieństwa jego pęknięcia

Krzysztof Maksymowicz1,2,, Magdalena Kobielarz3,2,, Joanna Czogała4,

1 Department of Forensic Medicine, Wroclaw Medical University, Poland

2 Regional Specialist Hospital in Wrocław, Research and Development Center, Poland

3 Division of Biomedical Engineering and Experimental Mechanics, Institute of Machine Design and Operation, Faculty of Mechanical Engineering, Wrocław University of Technology, Poland

4 Electron Microscope Laboratory, Wrocław University of Environmental and Life Sciences, Poland

Abstract

Because of the increasing incidence of abdominal aortic aneurysm (AAA) this disease poses a serious epidemiological problem, particularly in the highly developed and developing countries in which the average age of the population is increasing. According to demographic forecasts, these trends will continue, with an incidence peak in the next two decades. With the current state of medical knowledge, it is impossible to prevent the formation and development of abdominal aortic aneurysms whereby the main treatment remains to be surgical intervention. Therefore, in the authors’ opinion, besides continuing to explore the aetiopathogenesis of this disease, it is sensible to search for the potential indicators of the degree of AAA development. The present analysis of the indicators of the degree of AAA development currently recognized shows that their significance varies widely among researchers. This paper presents a review of information about the three main indicators of the degree of abdominal aortic aneurysm development: AAA maximum diameter, growth rate and mural thrombus presence. When searching for more objective indicators of AAA rupture probability and AAA development degree, researchers have become interested in indicators which might be the direct reflection of the structural changes taking place in the aortic wall. In the present authors’ opinion, the evaluation of the mechanical properties of AAA walls holds the greatest promise for the reliable assessment of AAA wall rupture probability and the degree of AAA development.

Streszczenie

Zwiększenie zachorowań na tętniaka aorty brzusznej (AAA) czyni tę chorobę poważnym problemem epidemiologicznym, zwłaszcza w populacji krajów wysoko rozwiniętych i rozwijających się, gdzie rośnie średnia wieku społeczeństw. Prognozy demograficzne wskazują na dalsze pogłębianie tych tendencji, z apogeum zachorowań w okresie kolejnych dwu dekad. Przy obecnym stanie wiedzy medycznej zapobieganie powstawaniu i rozwojowi tętniaków aorty brzusznej jest niemożliwe, dlatego nadal zasadniczym leczeniem jest interwencja chirurgiczna. Zatem, w opinii autorów na obecnym poziomie wiedzy medycznej, poza dalszym wyjaśnianiem etiopatogenezy choroby, celowe jest poszukiwanie, sklasyfikowanie i określenie znaczenia potencjalnych wskaźników stopnia rozwoju tętniaków aorty brzusznej. Wniosłoby to nowe dane do badań nad etiopatogenezą choroby oraz pozwoliłoby na zobiektywizowanie wskazań do leczenia chirurgicznego w odniesieniu do oceny ryzyka pęknięcia ściany tętniaka. Przeprowadzona w niniejszej pracy analiza uznanych obecnie wskaźników stopnia rozwoju tętniaka aorty brzusznej wskazuje na zróżnicowane ich znaczenie, a nawet krańcowo odmienne poglądy poszczególnych badaczy co do znaczenia tych wskaźników. Zwolennicy powyższych wskaźników wskazują na łatwość użycia, a przeciwnicy na niedokładność, pośredni charakter oraz duże ryzyko popełnienia błędu związanego z ich oceną. W pracy dokonano przeglądu wiedzy na temat trzech podstawowych, stosowanych obecnie, wskaźników stopnia rozwoju tętniaka aorty brzusznej: kryterium maksymalnej średnicy, współczynnika wzrostu, a także znaczenia skrzepliny przyściennej. Poszukiwanie bardziej obiektywnych wskaźników prawdopodobieństwa pęknięcia tętniaka oraz stopnia jego rozwoju skłoniło badaczy do zainteresowania się wskaźnikami, które byłyby odzwierciedleniem przemian strukturalnych zachodzących w ścianie aorty. Autorzy sądzą, że największe szanse na wiarygodne prognozowanie prawdopodobieństwa pęknięcia ściany tętniaka oraz określenie stopnia jego rozwoju rokuje ocena właściwości mechanicznych ścian tętniaków aorty brzusznej.

Key words

abdominal aortic aneurysm, maximum diameter criterion, growth rate, mural thrombus

Słowa kluczowe

tętniak aorty brzusznej, kryterium maksymalnej średnicy, współczynnik wzrostu, skrzeplina przyścienna

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