MULTIPLE ANEURYSMAL DISEASE: A REVIEW
Introduction: The degeneration of arterial aneurysms is a common manifestation of atherosclerosis, a process that involves the arterial vasculature, occurring in several arterial territories. With the increase of life expectancy, the number of patients with arterial aneurysms has increased, since its prevalence raises with age. Society of Vascular Surgery classifies arterial aneurysms according to their etiology. The most common form is the degenerative aneurysm, which can result from arterial wall degeneration due to several factors - genetic, inflammatory and/or environmental. Multiple aneurysms are more common in patients with arterial aneurysms of the lower limbs, especially in the popliteal artery. These aneurysms are associated with a high risk of morbidity, ischemic symptoms and a poor prognosis. A relationship between abdominal aortic aneurysms and lower extremities aneurysms will be discussed in this review.
Objectives: Recent studies report new possible etiologies for multiple aneurysmal disease. The purpose of this review is to report what’s new concerning causes, epidemiology, diagnosis and treatment of the multiple aneurysmal disease of the abdominal aorta and the lower extremities’ arteries.
Methods: An initial search was conducted in PubMed that gathered articles, written in English and Portuguese, within a time period from 1960 to 2019. Only the articles containing information about the main topics covered by this review were selected and an effort was made to cite the most recent ones (from 2001 to 2018).
Development: Multiple aneurysmal disease is rare and affects mainly the male sex. Multiple arterial aneurysms manifest as a systemic vascular disease and have been associated with multiple disorders. Atherosclerosis, vasculitis (polyarteritis nodosa and Behçet’s disease, infectious mycotic aneurysms and hereditary conditions, such as Marfan’s syndrome and Ehlers-Danlos are some of the most involved. The incidence of femoral and popliteal aneurysms in persons with abdominal aortic aneurysms appears higher than that noted previously. Ultrasound scanning is appropriate to the recognition of these peripheral aneurysms among patients with abdominal aortic disease. Because the complications can be serious, the early diagnosis assumes great importance for the prevention of complications associated with great morbidity. The role and the challenges associated with genetic tests to determine susceptibility for multiple aneurysmal disease are discussed in this review.
Conclusion: Multiple aneurysmal disease is rare, and in most cases, symptoms are vague. New methods for early diagnosis and surgical reconstruction are needed to allow adequate intervention and to prevent complications. Also, multiple arteries should be surveyed when an aneurysm is suspected or detected at one site, especially in patients with risk factors and in those who present with an isolated aneurysm in the lower extremities.
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