[Medical treatment of aortic abdominal aneurysms. Outstanding questions]

The low mortality of programmed surgical treatment of aortic abdominal aneurysms (2-4%) contrasts with a high mortality of surgical treatment in case of rupture (70-90%). These data underline the benefit of a "prophylactic" surgical treatment of aortic abdominal aneurysms, even those of small size or in older patients. Recently, experimental models and results of a few clinical studies suggest that medical treatment with beta-adrenergic blocking agents may reduce the expansion rate of aortic abdominal aneurysms and thus lower the risk of rupture. Several questions remains open. Should beta-blocking agents be reserved for aneurysms more than 5 cm in diameter in patients with a contraindication for surgery, or on the contrary proposed for aneurysms less than 4 cm in diameter in patients still free of contraindications? What is the mode and delay of action for beta-blockers, their effect on modulating blood pressure and their contribution to the use of endoluminal prostheses? Controlled prospective trials enrolling a large number of patients are required to answer these questions.