Treatment of abdominal aortic aneurysms: the role of endovascular repair.

Rupture of an abdominal aortic aneurysm (AAA) is a significant cause of mortality in the United States. Often asymptomatic, AAA is considered a silent killer because it frequently remains undiagnosed until the time of rupture or the patient's death. Major risk factors, such as smoking, age, sex, race, and family history of aortic aneurysm, affect the formation of AAAs. National screening recommendations and advancements in treatment modalities during the past 20 years have improved morbidity and mortality, especially with the introduction of stent grafts for endovascular repair of the aorta. Endovascular aneurysm repair is less invasive than open surgical repair. This article describes the major risk factors, pathophysiology, and diagnosis of AAA; patient selection for endovascular repair; common adverse events and complications; and perioperative implications for the patient undergoing endovascular repair of an AAA. Knowing the treatment options for patients with AAA who are at high risk for rupture should allow clinicians to determine the best course of immediate and long-term care. Patients who undergo endovascular repair of an AAA should receive lifelong monitoring for complications, especially endoleaks.

Effects of diabetes on the vascular system: current research evidence and best practice recommendations.

Diabetes mellitus has been referred to as a vascular disease because of its effect on the vascular endothelial wall. In recent years, research has identified specific effects of hyperglycemia and insulin resistance on the vasculature of the diabetic patient. Atherosclerosis is known to develop earlier in the diabetic patient and is more aggressive due to the metabolic effects of hyperglycemia and insulin resistance. The results of many large, randomized, prospective trials have provided practice changes in the management of the patient with diabetes. Trials such as the Framingham Study identified risk factors associated with atherosclerosis. Additional studies, such as the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study, provided information about risk factors for diabetes and contributed to treatment recommendations for the person with type 1 or type 2 diabetes. Results of these and many other trials continue to change the recommendations for the person with diabetes to reduce mortality and prevent coronary heart disease, blindness, renal failure, and amputation. This paper will identify the effects of diabetes on the vascular system and outline best practice recommendations on the basis of clinical trials.