Will medical therapy replace surgery for thoracic aneurysms?

Recent epidemiologic studies have shown lower rates of AAA.  Many ascribe this to better chronic treatment of hypertension.

Now Danyi et al have written a review article highlighting the potential for medical therapy to replace some surgery for thoracic aneurysms.

Specifically, they describe molecular mechanisms that may lead to aneurysm formation, and how:

  • Angiotensin receptor blockers (ARBs) are thought to inhibit the above pathways via inhibition of the AT1 receptors.
  • Angiotensin-converting enzyme inhibitors (ACEIs) block angiotensin II.
  • Statins block the NADH/NADPH system;
  • tetracyclines and macrolides reduce MMP activity. β-Blockers reduce shear stress on the vessel.

Given the high M&M of thoracic aortic surgery, even with endovascular and hybrid approaches, these are hopeful advances.

Fig. 2. MRI parasagittal gated image showing a saccular aneurysm of the aortic isthmus just distal to the left subclavian artery (white arrow). The cine-gradient echo image signal intensity in the aneurysm is inhomogeneous because of the intraluminal turbulence.


Comments are closed.