Abdominal aortic aneurysm medical therapy

Abdominal Aortic Aneurysm Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Aarti Narayan, M.B.B.S [3]

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.

Medical Therapy

Management

• Risk factor modification
  • Smoking cessation
    • Contributes to formation and rupture of aneurysm
    • Individuals with family history of abdominal aortic aneurysms should be advised to stop smoking
• ACEI, beta blockers and statins:
  • Risk factors for atherosclerosis like hypertension and hyperlipidemia should be controlled
  • Their use may also prolong survival by preventing progression of cardiac and cerebrovascular disease
  • Statins may reduce mortality in patients who have undergone an abdominal aortic aneurysm repair

aspirin, antibiotics for possible chlamydia infection

• Assess for coronary, carotid and peripheral vascular disease
• Surveillance:
  • 4 to 5.4 cm - monitor every 6 to 12 months
  • 3 to 4 cm - monitor every 2 to 3 years

Acute pharmacotherapies

• Antimetalloproteases such as doxycycline and roxithromycin may halt aneurysm expansion
• Similarly, non-steriod anti inflammatory drugs have shown to be beneficial in small studies
• Beta blockers have numerous benefits in patients with cardiovascular disease

  • Reduce aortic complications in patients with Marfan syndrome
  • Slow progression of AAAs in hypertensive patients
  • In the absence of other indications for beta blockers, the evidence is insufficient to recommend using them routinely for the sole purpose of slowing atherosclerotic aneurysm growth