MULTIPLE ANEURYSMAL DISEASE: A REVIEW

Authors

  • Mariana Lemos Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto, Porto, Portugal
  • Ivone Silva Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto, Porto, Portugal; Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto, Porto, Portugal
  • Rui Almeida Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto, Porto, Portugal; Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto, Porto, Portugal

DOI:

https://doi.org/10.48750/acv.227

Keywords:

Multiple Aneurysms, Arterial, Etiology, Diagnosis, Treatment

Abstract

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.

Downloads

Download data is not yet available.

References

1. Sidawy AN, Perler BA. Rutherford's Vascular Surgery and Endovascular
Therapy. 9th edition ed: Elsevier; 2018.
2. Dent TL, Lindenauer SM, Ernst CB, Fry WJ. Multiple arteriosclerotic
arterial aneurysms. Arch Surg. 1972;105(2):338-44.
3. Jackson BB. Surgery of acquired vascular disorders: Thomas; 1969.
4. Diwan A, Sarkar R, Stanley JC, Zelenock GB, Wakefield TW. Incidence of
femoral and popliteal artery aneurysms in patients with abdominal
aortic aneurysms. J Vasc Surg. 2000;31(5):863-9.
5. Harbuzariu C, Duncan AA, Bower TC, Kalra M, Gloviczki P. Profunda
femoris artery aneurysms: association with aneurysmal disease
and limb ischemia. J Vasc Surg. 2008;47(1):31-4; discussion 4-5.
6. Gutierrez PS, Leite TN, Mangione FM. Male gender and smoking
are related to single, but not to multiple, human aortic aneurysms.
Cardiovasc Pathol. 2015;24(5):290-3.
7. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et
al. ACC/AHA 2005 Practice Guidelines for the management of patients
with peripheral arterial disease (lower extremity, renal, mesenteric,
and abdominal aortic): a collaborative report from the American Association
for Vascular Surgery/Society for Vascular Surgery, Society for
Cardiovascular Angiography and Interventions, Society for Vascular
Medicine and Biology, Society of Interventional Radiology, and the ACC/
AHA Task Force on Practice Guidelines (Writing Committee to Develop
Guidelines for the Management of Patients With Peripheral Arterial
Disease): endorsed by the American Association of Cardiovascular and
Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute;
Society for Vascular Nursing; TransAtlantic Inter-Society Consensus;
and Vascular Disease Foundation. Circulation. 2006;113(11):e463-654.
8. Hirsch JH, Thiele BL, Carter SS, Colacurcio C. Aortic and lower
extremity arterial aneurysms. J Clin Ultrasound. 1981;9(1):29-31.
9. Naha K, Vivek G, Shetty RK, Dias LS. Multiple idiopathic arterial aneurysms
masquerading as aortic dissection. BMJ Case Rep. 2013;2013.
10. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC.
Suggested standards for reporting on arterial aneurysms. Subcommittee
on Reporting Standards for Arterial Aneurysms, Ad Hoc
Committee on Reporting Standards, Society for Vascular Surgery
and North American Chapter, International Society for Cardiovascular
Surgery. J Vasc Surg. 1991;13(3):452-8.
11. Yamamoto N, Unno N, Mitsuoka H, Uchiyama T, Saito T, Kaneko H, et
al. Clinical relationship between femoral artery aneurysms and arteriomegaly.
Surg Today. 2002;32(11):970-3.
12. D'Andrea V, Malinovsky L, Cavallotti C, Benedetti Valentini F,
Malinovska V, Bartolo M, et al. Angiomegaly. J Cardiovasc Surg
(Torino). 1997;38(5):447-55.
13. de Franciscis S, Mastroroberto P, Gallelli L, Buffone G, Montemurro R,
Serra R. Increased plasma levels of metalloproteinase-9 and neutrophil
gelatinase-associated lipocalin in a rare case of multiple artery aneurysm.
Ann Vasc Surg. 2013;27(8):1185 e5-7.
14. van Laake LW, Vainas T, Dammers R, Kitslaar PJ, Hoeks AP, Schurink GW.
Systemic dilation diathesis in patients with abdominal aortic aneurysms:
a role for matrix metalloproteinase-9? Eur J Vasc Endovasc Surg.
2005;29(4):371-7.
15. De Meyer T, Rietzschel ER, De Buyzere ML, Langlois MR, De Bacquer D,
Segers P, et al. Systemic telomere length and preclinical atherosclerosis:
the Asklepios Study. Eur Heart J. 2009;30(24):3074-81.
16. Atturu G, Brouilette S, Samani NJ, London NJ, Sayers RD, Bown MJ.
Short leukocyte telomere length is associated with abdominal aortic
aneurysm (AAA). Eur J Vasc Endovasc Surg. 2010;39(5):559-64.
17. Bjorck M, Ravn H, Nilsson TK, Wanhainen A, Nilsson PM. Blood cell
telomere length among patients with an isolated popliteal artery
aneurysm and those with multiple aneurysm disease. Atherosclerosis.
2011;219(2):946-50.
18. Ravn H, Bergqvist D, Bjorck M, Swedish Vascular R. Nationwide study
of the outcome of popliteal artery aneurysms treated surgically.
Br J Surg. 2007;94(8):970-7.
19. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et
al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases:
Document covering acute and chronic aortic diseases of the thoracic
and abdominal aorta of the adult. The Task Force for the Diagnosis and
Treatment of Aortic Diseases of the European Society of Cardiology (ESC).
Eur Heart J. 2014;35(41):2873-926.
20. Lun Y, Jiang H, Jing Y, Xin S, Zhang J. Saphenous vein graft aneurysm
formation in a patient with idiopathic multiple aneurysms. J Vasc Surg
Cases Innov Tech. 2018;4(3):197-200.
21. Lijnen HR. Metalloproteinases in development and progression of
vascular disease. Pathophysiol Haemost Thromb. 2003;33(5-6):275-81.
22. Keser G, Aksu K, Direskeneli H. Takayasu arteritis: an update. Turk J
Med Sci. 2018;48(4):681-97.
23. Mei F, Yu M, Li Y, Jin B, Ouyang C. Treatment of multiple aneurysms.
Ann Vasc Surg. 2014;28(8):1937 e13-7.
24. Hernandez-Rodriguez J, Alba MA, Prieto-Gonzalez S, Cid MC. Diagnosis
and classification of polyarteritis nodosa. J Autoimmun. 2014;48-49:84-9.
25. Ekici F, Varan B, Kocabas A, Erdogan I, Eminoglu S, Aktas D. Multiple
giant aneurysms and stenoses of the coronary and systemic arteries
in an infant with kawasaki disease at the early stage of convalescent
period. Echocardiography. 2014;31(5):E147-50.
26. Roy S, Biswas MK. Multiple Systemic Aneurysms in a Case of Neglected
Kawasaki Disease. J Paediatr Child Health. 2019;55(1):117.
27. Hoshino S, Tsuda E, Yamada O. Characteristics and Fate of
Systemic Artery Aneurysm after Kawasaki Disease. J Pediatr.
2015;167(1):108-12 e1-2.
28. Bartlett ST, McCarthy WJ, 3rd, Palmer AS, Flinn WR, Bergan JJ, Yao JS.
Multiple aneurysms in Behcet's disease. Arch Surg. 1988;123(8):1004-8.
29. Ali O, Nicholl P, Carruthers D, Geoghegan J, Tiwari A. Multiple Aneurysms
and a Transplanted Kidney in Behcet Disease. Vasc Endovascular
Surg. 2017;51(2):108-10.
30. Sonesson B, Hansen F, Lanne T. Abnormal mechanical properties of
the aorta in Marfan's syndrome. Eur J Vasc Surg. 1994;8(5):595-601.
31. de Virgilio C, Cherry KJ, Jr., Schaff HV. Multiple aneurysms and
aortic dissection: an unusual manifestation of Marfan's syndrome.
Ann Vasc Surg. 1994;8(4):383-6.
32. Pannu H, Fadulu VT, Chang J, Lafont A, Hasham SN, Sparks E, et
al. Mutations in transforming growth factor-beta receptor type II
cause familial thoracic aortic aneurysms and dissections. Circulation.
2005;112(4):513-20.
33. Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H,
et al. Aneurysm syndromes caused by mutations in the TGF-beta
receptor. N Engl J Med. 2006;355(8):788-98.
34. Oderich GS, Panneton JM, Bower TC, Lindor NM, Cherry KJ, Noel AA, et
al. The spectrum, management and clinical outcome of Ehlers-Danlos
syndrome type IV: a 30-year experience. J Vasc Surg. 2005;42(1):98-106.
35. Oka N, Aomi S, Tomioka H, Endo M, Koyanagi H. Surgical treatment
of multiple aneurysms in a patient with Ehlers-Danlos syndrome.
J Thorac Cardiovasc Surg. 2001;121(6):1210-1.
36. Dickinson KJ, Parry DJ, Sandoe JA, Gough MJ. Multiple peripheral
pneumococcal mycotic aneurysms without aortic involvement:
a unique case confirmed with the novel use of a molecular diagnostic
technique. J Vasc Surg. 2007;45(6):1253-5.
37. Coutu M, Blair JF. Multiple mycotic aortic aneurysms due to Streptococcus
pneumoniae. Ann Vasc Surg. 2003;17(5):554-7.
38. Harding GE, Lawlor DK. Ruptured mycotic abdominal aortic aneurysm
secondary to Mycobacterium bovis after intravesical treatment with
bacillus Calmette-Guerin. J Vasc Surg. 2007;46(1):131-4.
39. Coscas R, Arlet JB, Belhomme D, Fabiani JN, Pouchot J. Multiple
mycotic aneurysms due to Mycobacterium bovis after intravesical
bacillus Calmette-Guerin therapy. J Vasc Surg. 2009;50(5):1185-90.
40. Duvnjak P, Laguna M. Left Anterior Descending Coronary Artery and
Multiple Peripheral Mycotic Aneurysms Due to Mycobacterium Bovis
Following Intravesical Bacillus Calmette-Guerin Therapy: A Case Report.
J Radiol Case Rep. 2016;10(8):12-27.
41. Saratzis A, Bown MJ. The genetic basis for aortic aneurysmal disease.
Heart. 2014;100(12):916-22.
42. Bjorck M, Wanhainen A. Pathophysiology of AAA: heredity vs environment.
Prog Cardiovasc Dis. 2013;56(1):2-6.
43. De Basso R, Sandgren T, Ahlgren AR, Lanne T. Increased cardiovascular
risk without generalized arterial dilating diathesis in persons who
do not have abdominal aortic aneurysm but who are first-degree
relatives of abdominal aortic aneurysm patients. Clin Exp Pharmacol
Physiol. 2015;42(6):576-81.
44. Crawford ES, Edwards WH, Debakey ME, Cooley DA, Morris GC, Jr.
Peripheral arteriosclerotic aneurysm. J Am Geriatr Soc. 1961;9:1-15.
45. Huang Y, Gloviczki P, Duncan AA, Kalra M, Hoskin TL, Oderich GS, et al.
Common iliac artery aneurysm: expansion rate and results of open surgical
and endovascular repair. J Vasc Surg. 2008;47(6):1203-10; discussion 10-1.
46. Lancashire MJ, Galland RB. Aneurysm of lateral circumflex femoral
artery in association with multiple atherosclerotic aneurysms.
Ann Vasc Surg. 1992;6(3):289-91.
47. Belhaj A, Chimanuka D, Rondelet B. Giant true aneurysm of superficial
femoral artery in patient with multiple atherosclerotic aneurysms:
A case report. Int J Surg Case Rep. 2017;35:94-7.
48. Leon LR, Jr., Taylor Z, Psalms SB, Mills JL, Sr. Degenerative aneurysms
of the superficial femoral artery. Eur J Vasc Endovasc Surg.
2008;35(3):332-40.
49. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al.
Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical
Practice Guidelines on the Management of Abdominal Aorto-iliac Artery
Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93.
50. Papadoulas S, Skroubis G, Marangos MN, Kakkos SK, Tsolakis JA.
Ruptured aneurysms of superficial femoral artery. Eur J Vasc Endovasc
Surg. 2000;19(4):430-2.
51. Honjo O, Yamada Y, Mima T, Kushida Y. Surgical treatment for an
atherosclerotic aneurysm of the superficial femoral artery: report
of a case. Surg Today. 2004;34(2):188-9.
52. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA,
et al. The Society for Vascular Surgery practice guidelines on the care
of patients with an abdominal aortic aneurysm. J Vasc Surg.
2018;67(1):2-77 e2.
53. Hama Y, Kaji T, Iwasaki Y, Kawauchi T, Yamamoto M, Kusano S. Endovascular
management of multiple arterial aneurysms in Behcet's disease.
Br J Radiol. 2004;77(919):615-9.
54. Goncu T, Sezen M, Vural H, Eris C, Yavuz S, Ozyazicioglu A. Sequential
development of multiple atherosclerotic peripheral arterial aneurysms
in a four-year period. Arch Med Sci. 2009;5(2):273-6.
55. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, et al.
2011 ACCF/AHA focused update of the guideline for the management
of patients with peripheral artery disease (updating the 2005 guideline):
a report of the American College of Cardiology Foundation/American
Heart Association Task Force on Practice Guidelines: developed
in collaboration with the Society for Cardiovascular Angiography and
Interventions, Society of Interventional Radiology, Society for Vascular
Medicine, and Society for Vascular Surgery. Catheter Cardiovasc Interv.
2012;79(4):501-31.
56. Crawford ES, Cohen ES. Aortic aneurysm: a multifocal disease.
Presidential address. Arch Surg. 1982;117(11):1393-400.
57. Mees B, Robinson D, Verhagen H, Chuen J. Non-aortic aneurysms -
natural history and recommendations for referral and treatment.
Aust Fam Physician. 2013;42(6):370-4.
58. Salzler GG, Long B, Avgerinos ED, Chaer RA, Leers S, Hager E, et
al. Contemporary Results of Surgical Management of Peripheral
Mycotic Aneurysms. Ann Vasc Surg. 2018;53:86-91.
59. Crawford ES, Coselli JS, Svensson LG, Safi HJ, Hess KR. Diffuse aneurysmal
disease (chronic aortic dissection, Marfan, and mega aorta
syndromes) and multiple aneurysm. Treatment by subtotal and
total aortic replacement emphasizing the elephant trunk operation.
Ann Surg. 1990;211(5):521-37.
60. Davis FM, Eliason JL, Ganesh SK, Blatt NB, Stanley JC, Coleman DM. Pediatric
nonaortic arterial aneurysms. J Vasc Surg. 2016;63(2):466-76 e1.

Downloads

Published

2019-10-16

How to Cite

1.
Lemos M, Silva I, Almeida R. MULTIPLE ANEURYSMAL DISEASE: A REVIEW. Angiol Cir Vasc [Internet]. 2019 Oct. 16 [cited 2024 Mar. 29];15(2):86-9. Available from: https://acvjournal.com/index.php/acv/article/view/227

Issue

Section

Review Article