Positron Emission Tomography Fluorine-18-Labeled 2-Deoxy-2-Fluoro- d -Glucose Tells a Complicated Story in the Aortic Aneurysm Wall

Abdominal aortic aneurysm (AAA) was first described in the second century by Antyllus, who surgically ligated the proximal and distal ends of the aneurysm. The modern treatment of AAA began with the first AAA replacement using a homograft in 1951. Since that time, the screening, diagnostic method, surveillance, and treatment of AAA have been very well studied and incorporated into a modern paradigm of care. The results of this work is the dramatic reduction in aneurysm-related mortality for patients who maintain care and contact with a healthcare provider. Indeed, in patients found to have an infrarenal aorta of 4 cm in diameter, aneurysm rupture or repair is the number 4 cause of death behind other cardiovascular, cancer, and lung disease, representing 6% to 8% of the total mortality.1,2See Article by Huang et al Epidemiological investigation has made clear the population of people most likely to have an AAA. Major risk factors for the disease include cigarette smoking, male sex, older age, and a family history of the disease. Screening studies have identified the population in whom the balance of screening and treatment is well founded. In the first 20 years of the Gloucestershire ultrasound screening program for AAA in men aged 65 years, 4.9% of the men were found to have an aneurysm worthy of surveillance or treatment.3 The value of screening in this population has been demonstrated both for reductions in aneurysm-related mortality and total mortality by the MASS (Multicenter Aneurysm Screening Study),4 a screening study including ≈67 000 men. On the basis of MASS and …