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

Journal of Vascular Surgery, 2011


[Epub ahead of print] Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder.
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).