aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder

Aortic Aneurysm


Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder


Antoniou GA, Georgiadis GS, Antoniou SA, et al (Democritus Univ of Thrace, Alexandroupolis, Greece; Hospital “Maria v. d. Aposteln” Neuwerk, Mönchengladbach, Germany) J Vasc Surg 54:1175–1181, 2011§



J.D. Raffetto, MD



Evidence Ranking


• A



Expert Rating


• 1



Abstract



Background


Abdominal aortic aneurysms (AAAs) and abdominal wall hernias represent chronic degenerative conditions. Both aortic aneurysms and inguinal hernias share common epidemiologic features, and several investigators have found an increased propensity for hernia development in patients treated for aortic aneurysms. Chronic inflammation and dysregulation in connective tissue metabolism constitute underlying biological processes, whereas genetic influences appear to be independently associated with both disease states. A literature review was conducted to identify all published evidence correlating aneurysms and hernias to a common pathology.



Methods


PubMed/Medline was searched for studies investigating the clinical, biochemical, and genetic associations of AAAs and abdominal wall hernias. The literature was searched using the MeSH terms “aortic aneurysm, abdominal,” “hernia, inguinal,” “hernia, ventral,” “collagen,” “connective tissue,” “matrix metalloproteinases,” and “genetics” in all possible combinations. An evaluation, analysis, and critical overview of current clinical data and pathogenic mechanisms suggesting an association between aneurysms and hernias were undertaken.



Results


Ample evidence lending support to the clinical correlation between AAAs and abdominal wall hernias exists. Pooled analysis demonstrated that patients undergoing aortic aneurysm repair through a midline abdominal incision have a 2.9-fold increased risk of developing a postoperative incisional hernia compared with patients treated for aortoiliac occlusive disease (odds ratio, 2.86; 95% confidence interval, 1.97-4.16; P < .00001), whereas the risk of inguinal hernia was 2.3 (odds ratio, 2.30; 95% confidence interval, 1.52-3.48; P < .0001). Emerging evidence has identified inguinal hernia as an independent risk factor for aneurysm development. Although mechanisms of extracellular matrix remodeling and the imbalance between connective tissue degrading enzymes and their inhibitors instigating inflammatory responses have separately been described for both disease states, comparative studies investigating these biological processes in aneurysm and hernia populations are scarce. A genetic predisposition has been documented in familial and observational segregation studies; however, the pertinent literature lacks sufficient supporting evidence for a common genetic basis for aneurysm and hernia.



Conclusions


Insufficient data are currently available to support a systemic connective tissue defect affecting the structural integrity of the aortic and abdominal wall. Future investigations may elucidate obscure aspects of aneurysm and hernia pathophysiology and create novel targets for pharmaceutical and gene strategies for disease prevention and treatment (Figs 1 and 2).


image

Figure 1 Meta-analysis of studies comparing the incidence of incisional hernias in patients with abdominal aortic aneurysms (AAAs) and aortoiliac occlusive disease (AOD). CI, Confidence interval; OR, odds ratio. (Reprinted from the Journal of Vascular Surgery, Antoniou GA, Georgiadis GS, Antoniou SA, et al. Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder. J Vasc Surg. 2011;54:1175–1181. Copyright 2011, with permission from The Society for Vascular Surgery.)

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Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder

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