title: Innovations in treating aortic diseases: the abdominal aorta.
abstract: Patients with an abdominal aortic aneurysm (AAA) could benefit from earlier diagnosis to improve long-term outcomes. Candidate serum biomarkers for earlier AAA diagnosis include D-dimer, fibrinogen, low-density lipoprotein, high-density lipoprotein, lipoprotein(a), and the proteolytic enzymes known as matrix metalloproteinases. Furthermore, biomarkers such as brain natriuretic peptide significantly stratify perioperative risk in AAA repair. Statins significantly improve outcomes after AAA repair. They may also significantly slow AAA growth to allow pharmacologic arrest of AAA development. Recent trials have focused attention on fluid management for AAA repair. Although restrictive fluid management may significantly improve clinical outcomes, current evidence does not clearly support crystalloid or colloid for AAA repair. There may be an increased risk of renal dysfunction associated with hetastarch therapy. Endovascular repair has revolutionized the clinical management of AAAs. Recent trials have shown its significant outcome advantages. Furthermore, it is also applicable in high-risk operative cohorts and, in the future, may be suited for earlier AAA repair. This technology continues to advance with the development of branched and fenestrated grafts as well as total percutaneous endovascular AAA repair. Regardless of these advances, the clinical management of endoleaks will remain a major clinical focus. Taken together, these advances in the management of AAAs likely will significantly influence future clinical approaches to this challenging patient cohort.
authors.affiliation: Department of Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Balachundar
authors.initials: B
authors.lastname: Subramaniam
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Christopher
authors.initials: C
authors.lastname: Roscher
authors.forename: John G T
authors.initials: JG
authors.lastname: Augoustides
mesh_terms: D001012:Aorta, Abdominal / Q000187:drug effects / Q000502:physiology* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D005440:Fluid Therapy / Q000379:methods / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D035703:Therapies, Investigational / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000639:trends
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors