Aneurysms prevalence

The endovascular procedure is most frequently used to treat infrarenal AAAs that are a leading cause of death in the older population, As our population ages, we will encounter AAAs more frequently than ever before. An aneurysm is defined by a size greater than 5 cm or 2.5 times the normal diameter of the native artery. Most aneurysms begin below the renal arteries and end close to the iliac bifurcation. More complicated AAAs exist involving the suprarenal aorta and visceral vessels and extending into the iliac arteries. The prevalence of AAAs is 3% to 10% for patients older than 50 years (I). They occur more frequently in men and reach a peak incidence close to the age of 80 years. AAA rupture is associated with an 80% to 90% mortality rate and therefore the focus of AAA treatment is on intervening before the aneurysm ruptures elective repair has mortality rate of less than 5%. 

The prevalence of aortic aneurysm in patients with stroke and TIA is unknown but is likely to be high, particularly if the patient has carotid stenosis (Ch. 6). 

Rinkel GJE, Djibuti M, AJgra A et al. (1998). Prevalence and risk of rupture of intracranial aneurysms a systematic review. Stroke 29 251-256... 

The prevalence of arterial aneurysms is estimated at between 2.7% and 22.7%, with a mean of about 10%. 

Brown RD, Wiebers DO, Forbes G et al. (1988) The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68 352-357 Brown RD, Wiebers DO, Forbes GS (1990) Unruptured intracranial aneurysms and arteriovenous malformations and relationship of lesions. J Neurosurg 73 859-863 Brown RD Jr, Wiebers DO, Torner JC, O Fallon WM (1996a) Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992. Neurology 46 949-952... 

The incidence of SAH in the Western hemisphere is around 6-10 per 100,000 people per year, peaking in the sixth decade with risk for SAH increasing linearly with age. The incidence of SAH in some other countries like Finland or Japan is known to be higher - about 15/100,000 per year - although the prevalence of intracranial aneurysms in Finland is similar to other countries comparable Japanese data regarding prevalence of intracranial aneurysms are lacking. SAH accounts for a quarter of cerebrovascular deaths. 

Jacobs I, Davies AP, Bridges J, Stabile I, Fay T, Lower A, Grudzin-skas JG, Oram D (1993) Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. BMJ 306 1030-1034 Jamrozik K, Norman PE, Spencer CA, Parsons RW, Tuohy R, Lawrence-Brown MM, Dickinson JA (2000) Screening for abdominal aortic aneurysm lessons from a population-based study. Med J Aust 173(7) 345-350 Kloos RT, Korobkin M, Thompson NW, Francis IR, Shapiro B, Gross MD (1997) Incidentally discovered adrenal masses. Cancer Treat Res 89 263-292... 

Endovascular treatment of aneurysms has focused on the mechanical aspects of the procedures but the prevalence of endoleaks and incomplete obliteration of intracranial aneurysms indicates there is ample room for improvement. An integrated approach where the mechanical device also serves as a scaffold for drug delivery has been proposed. In this scheme, the coils deployed within the aneurysm might also be coated with a drug which promotes intimal hyperplasia and the intimal hyperplasia helps seal the aneurysm neck. 

Englesbe MJ, Wu AH, Clowes AW, Zierler RE (2003) The prevalence and natural history of aortic aneurysms in heart and abdominal organ transplant patients. JVasc 8urg 37 27-31... 

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