The Formation of Aneurysms

Arterial aneurysms account for a significant proportion of the various diseases treated by the vascular surgeon. Refinements of surgical technique have reduced the morbidity and mortality, yet, we have no effective medical therapy to prevent the growth of small aneurysms. Although the pathogenesis of aneurysmal disease has received attention, the complex nature of the process has not been fully elucidated. The emergence of new and refined techniques in the fields of immunology, biochemistry, cell biology, and genetics has advanced the understanding of the dynamic interactions within a diseased vessel. Although past work was descriptive, investigators are now studying the role of the local inflammatory infiltrates and the destructive proteolytic enzymes they produce and regulate. The clinical observations we make regarding the familial tendency of abdominal aortic aneurysms (AAA) underscores the importance of research directed at identifying an aneurysm-related gene. As new pieces are added to the puzzle and the picture of AAA pathogenesis becomes more clear, we can expect the development of new therapeutic measures directed at controlling the critical matrix changes, and thus the growth of small AAA, as well as screening methods searching for AAA-associated genes.