Correspondence to: Rebecka Hultgren (email: rebecka.hultgren@ki.se)
Department of Vascular Surgery
Karolinska Institutet
Stockholm, Sweden
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BJS, https://doi.org/10.1093/bjs/znaf156, published 20 August 2025
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Dear Editor
We thank Manenti et al. for their comment and agree with their observation regarding the potential opposite directions of aortic diseases; occlusive or aneurysmatic as reported recently1. It remains unclear which disease the aortic wall for the individual patients will develop, since the underlying risk factor profile may remain quite similar, perhaps apart from the diabetic patient.
We agree that patients with small aortic diameters detected in the aneurysm screening likely represent a group with prevalent vascular disease in other arterial territories.
Presumably this feature of the aorta should be considered a surrogate marker of increased risk, rather than a causal factor affecting mortality. This surrogate marker may indicate the necessity of adequate preventive measures when called for, such as aggressive lipid lowering strategies and blood pressure management. Although the increased risk of premature death has been shown by others1–5, and now confirmed in this population-based screening programme, no clear general prevention strategy exists for this rather large group of men. These results do altogether indicate that such strategies should be developed, after in-depth analysis of cost-effectiveness.
References
1.Siika A, Axelsson A, Fattahi N, Roy J, Öhman D, Linné A et al. Decreasing aortic diameter decreasing prevalence of infrarenal aortic aneurysms in a population-based screening programme. BJS 2025; 112, doi: https://doi.org/10.1093/bjs/znaf156
2.Jones GT, Drinkwater B, Blake-Barlow A, Hill GB, Williams MJA, Krysa J et al. Both Small and Large Infrarenal Aortic Size is Associated with an Increased Prevalence of Ischaemic Heart Disease. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg 2020; 60: 594–601.
3.Liu J, Jia X, Jia S, Qin X, Zhang T, Liu L et al. Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adults. Sci Rep. 2017; 7: 14547.
4.van den Bosch MAAJ, van der Graaf Y, Eikelboom BC, Algra A, Mali WPThM. Distal aortic diameter and peripheral arterial occlusive disease. J Vasc Surg 2001; 34: 1085–1089.
5.Norman PE, Muller J, Golledge J. The cardiovascular and prognostic significance of the infrarenal aortic diameter. J Vasc Surg 2011; 54: 1817–1820.
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