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I am reviewing two clinical papers this month, because they lead to
discussion of recent findings in our research laboratory, which may
point the way towards a molecular explanation for clinical facts.
1. Santilli SM, Wernsing SE, Lee ES. Expansion rates and outcomes
for iliac artery aneurysms. J Vasc Surg 2000; 31: 114-21.
Brief summary: The authors searched the records of a large university
associated Veterans Admin hospital (1990-99) and found 189 patients
with a 323 iliac artery aneurysms (IAA). As I interpret the presentation
of the data, 322 of these aneurysms involved the common and/or
internal iliac artery, and only 1 involved the external. The reader is
referred to the paper for details, but the bottom line is as follows:
1. <3 cm IA can be followed by ultrasound annually
2. 3.0 - 3.5 should be followed every 6 months
3. >3.5 should be considered for repair in good-risk patients
4. >4 should be considered for repair
5. >5 should have "prompt" operative repair.
2. Ballotta E, DaGiau G, Bottio T. Elongation of the internal carotid
artery and abdominal aortic aneurysm: Is there a relationship?
J Cardiovasc Surg 1999; 40: 21-6
Brief Summary: Yes.
The authors report a series of 43 patients with elongated ICA and
AAA.
Comments by mdt: So why do some patients with AAA get aneurysms
of the common iliac (but not external), and why do some get elongation
of the carotid artery. In my laboratory this year a student named David
Syn has done some experiments that may lead to an answer. We
have raised antibodies against unique sequences of three aortic
proteins that are candidate autoantigens in AAA disease. Interestingly,
two were not detectable in external iliac artery, and two were conspicuous
in the carotid artery.