Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Review Article

Abdominal Aortic Aneurysm (AAA) is defined as a localized and permanent dilatation of the abdominal aorta, beyond 50% of the normal aorta diameter (Schermerhorn, 2009). The prevalence of AAA ranges from 1.3% to 8.9% in men and 1% to 2.2% in women (Sakalihasan et al., 2005; Singh et al., 2001). Incidence of AAA is on the rise in parallel with a globally ageing population, higher clinical suspicion and improved accuracy of imaging methods (Best et al., 2003; Prisant & Mondy, 2004). AAA is an important problem for public health, since AAA rupture is the tenth leading cause of death in American white men 65 to 74 years of age (Upchurch & Schaub, 2006). Most AAA remain asymptomatic until rupture occurs. Half of the patients with a ruptured AAA reach the hospital alive, with an additional operative mortality of 30-60%. On the contrary, an elective AAA repair, recommended in most patients with an abdominal aortic diameter exceeding 50-55 mm or rapid growth (> 1 cm/y), is associated with a mortality risk of 2% to 6% (Kurvers at al., 2003; Sakalihasan et al., 2005). Health organizations recently recommended one-time screening for AAA by ultrasonography for men aged between 65 and 75 years with a smoking history, thereby reducing AAA related mortality rates by 50% (Cosford & Leng, 2007; Ehlers et al., 2008; Ferket et al., 2011; Moxon et al., 2010; Takagi et al., 2010). However, they advised against screening in men below 65 and over 75 years, and in women, since the number of AAArelated deaths that can be prevented by screening these populations is too small. AAA and atherosclerosis share several risk factors, such as male sex, age, smoking and arterial hypertension (Forsdahl et al., 2009). In population – based studies, AAA is independently associated with pre – existing coronary arterial disease (CAD) (Golledge et al., 2006; Kent et al., 2010). The high prevalence of CAD among patients with AAA is well known, with an impact on short term survival after AAA repair (Falk et al., 1997). Indeed, coronary investigation is often required prior to aortic surgery, finding a concomitant CAD prevalence of 31% to 90% (Kioka et al., 2002; Sukhija et al., 2004; Van Kuijk et al., 2009). In contrast, the opposite relationship, namely the prevalence of AAA among patients with CAD, has been explored only in some recent cohorts or in subgroups of patients. The possibility that AAA could be more prevalent in this population, as compared with the general population, has been suggested by these previous studies, with limited, incomplete