[Abdominal aortic aneurysms in elderly subjects]

Abdominal aortic aneurysms (AAA) preferentially affect elderly subjects, especially men. Its pathogenesis is complex and multifactorial and even if clinical and fundamental research has led to a better understanding of the disease, several aspects remain unknown. Natural history consists of progressive aneurismal expansion leading to rupture which is associated with a high mortality rate (48.5% in-hospital and 80% global mortality). Screening for AAA and regular follow-up have been recognized as efficient strategies in order to prevent rupture, and screening programs have now to include women because the prognostic of the disease is more severe in women. Medical management of patients with AAA includes both limitation of aneurismal expansion rate and treatment of associated cardiovascular risk factors. Intervention is proposed when the maximal diameter of AAA reaches 50-55mm in men, and 45-50mm in women and the choice between open or endovascular repair depends on comorbidities and AAA anatomy. New therapies including specific therapy of the aneurismal wall such as cell or gene therapy could be proposed in the future.