Aortic Aneurysm Mechanics and Management

Aortic aneurysm arises from progressive weakening and dilation of the aortic wall, resulting in a bulge that may rupture if left untreated. Mechanical integrity of the aorta depends on the hierarchical arrangement of vascular smooth muscle cells, elastin, collagen and the extracellular matrix (ECM). Disruption of this structure can be triggered by genetic predisposition, inflammatory cell infiltration, proteolytic enzyme activation and biomechanical stress. Screening and surveillance rely on imaging modalities to measure aneurysm diameter and growth rate, guiding decisions for elective intervention. Pharmacological approaches have largely focused on anti-inflammatory strategies and modulation of protease activity, but no drug has yet been approved to halt aneurysm expansion. Definitive management of aneurysms exceeding size or growth thresholds comprises open surgical repair or endovascular aneurysm repair (EVAR), each balancing procedural risk and long-term durability. Advances in stent-graft technology, perioperative care and risk stratification have improved outcomes, yet unanswered questions remain regarding optimal timing, patient selection and preventative medical therapies. Continued integration of biomechanics, molecular biology and clinical research is essential to reduce global morbidity and mortality from this silent but life-threatening condition.

Research from Nature Portfolio

Recent genetic studies have identified more than a hundred susceptibility loci that collectively underpin abdominal aortic aneurysm risk. Insights into loci associated with lipid metabolism, transforming growth factor β signalling and extracellular matrix remodelling have clarified mechanistic pathways and revealed opportunities for therapeutic repurposing. Notably, evidence from causal inference studies highlights non-high-density lipoprotein cholesterol as a modifiable determinant of aneurysm development, supporting the prospect of low-density lipoprotein-lowering treatments such as proprotein convertase subtilisin/kexin-type 9 inhibitors. In parallel, investigations into small non-coding RNAs have demonstrated that specific microRNAs regulate vascular inflammation and matrix degradation, with experimental modulation of these molecules in animal models altering aneurysm progression and suggesting novel biomarker and therapeutic targets.

Aortic Aneurysm Mechanics and Management publication trend

The graph below shows the total number of articles in aortic aneurysm mechanics and management across all publications each year (not limited to Nature Index journals).

Technical terms

Extracellular matrix (ECM): Network of structural proteins and glycoproteins that provides mechanical support and biochemical cues within the aortic wall.

Matrix metalloproteinases (MMPs): Family of zinc-dependent enzymes that degrade ECM components, contributing to aneurysm formation.

Endovascular aneurysm repair (EVAR): Minimally invasive procedure that excludes an aneurysm from blood flow using a stent-graft delivered through the femoral arteries.

Polygenic risk score: Composite measure of genetic susceptibility calculated by summing effects of multiple risk variants across the genome.

MicroRNA (miRNA): Short non-coding RNA molecules that regulate gene expression at the post-transcriptional level, influencing vascular cell function.

References

1. The mechanism and therapy of aortic aneurysms. Signal Transduction and Targeted Therapy (2023).
2. Genome-wide association meta-analysis identifies risk loci for abdominal aortic aneurysm and highlights PCSK9 as a therapeutic target. Nature Genetics (2023).
3. miR-24 limits aortic vascular inflammation and murine abdominal aneurysm development. Nature Communications (2014).
4. Extracellular matrix, regional heterogeneity of the aorta, and aortic aneurysm. Experimental & Molecular Medicine (2019).
5. Matrix Metalloproteinase in Abdominal Aortic Aneurysm and Aortic Dissection. Pharmaceuticals (2019).
6. Abdominal Aortic Aneurysm: Roles of Inflammatory Cells. Frontiers in Immunology (2021).
7. Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial. The BMJ (2017).