الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Abdominal aortic aneurysm (AAA) can be defined as
an abdominal aortic diameter of 3.0 cm in either
anteriorposterior or transverse planes. Prevalence rates
of AAA vary according to age, gender and geographical
location. Important risk factors for AAA are advanced
age, male gender, smoking and a positive family history
for AAAs. (Schlo¨sser et al.,2008)
The reported average growth rate of AAAs between
3.0 and 5.5 cm ranges from 0.2 to 0.3 cm per year.
Larger AAA diameters are associated with higher AAA
growth rates. (Schlo¨sser et al.,2008)
A wide variation between patients has been reported
consistently. Smoking cessation may be recommended
to reduce the rate of AAA growth. Larger initial aneurysm
diameter is a significant and independent risk factor for
AAA rupture. (Schlo¨sser et al.,2008)
Other factors that have been associated with an
increased risk of AAA rupture include female gender,
smoking and hypertension. Population screening of older
men for AAA, in regions where the population prevalence
is 4% or more, reduces aneurysm-related mortality by
almost half within 4 years of screening, principally by
reducing the incidence of aneurysm rupture. Screening
only smokers might improve the cost-effectiveness of
aneurysm screening. (Vega et al.,2006)
Population screening of older women for AAA may not
reduce the incidence of aneurysm rupture. Population screening of older female smokers for AAA may require
further investigation. Screening of older men and women
having a family history of AAA might be recommended.
Opportunistic screening of patients with peripheral
arterial disease should be considered. The screening
model chosen should be flexible for the local population
characteristics. Men should be screened with a single
scan at 65 years old. Screening should be considered at
an earlier age for those at higher risk for AAA. Repeat
screening should be considered only in those initially
screened at a younger age or at higher risk for AAA.
(Vega et al.,2006)
Screening programmes should be well advertised and
tailored to the local population to maximise attendance.
Invitation to screening from the general or family
practitioner might be received favourably. Incidental
pathology should be referred to the family practitioner. If
screening programmes use relatively inexperienced
screening staff and portable ultrasound devices,
programmes should be audited for quality control. (Solberg
et al.,2005)
Screen detection of an AAA causes a small but
temporary reduction in quality of life. Aneurysm
screening should only be conducted if the audited
mortality from aneurysm repair at the referral hospital is
low. Referral hospital facilities must be in place before
AAA screening starts to cope with an increased number
of elective AAA repairs, both open and endovascular.
(Vega et al.,2006) All subjects with a screen-detected aneurysm should be
referred for cardiovascular risk assessment with
concomitant advice and treatment, including statins and
smoking cessation therapy. Rescreening intervals should
shorten as the aneurysm enlarges. (Solberg et al.,2005)
When the threshold diameter (5.5 cm, measured by
ultrasonography, in males) is reached or symptoms
develop or rapid aneurysm growth is observed (>1
cm/year), immediate referral to a vascular surgeon is
recommended. To prevent interval rupture, it is
recommended that a vascular surgeon review patients
within 2 weeks of the aneurysm reaching 5.5 cm or more
in diameter. In some centres an earlier referral, at
between 5.0 and 5.5 cm is an acceptable alternative
practice. In-patient management might be considered for
aneurysms over 9 cm in diameter. A policy of
ultrasonographic surveillance of small aneurysms
(4.0e5.5 cm) is safe and advised for asymptomatic
aneurysms. (Dalman et al.,2006)
Patients with a higher risk of rupture should be
considered for surgery when the maximum aortic
diameter reaches 5.0 cm. There remains some
uncertainty about the management of small aneurysms
in defined subgroups (e.g. young patients, females, and
those with limited life expectancy). Females should be
referred to vascular surgeons for assessment at a
maximum aortic diameter of 5.0 cm as measured by
ultrasonography, and aneurysm repair should be considered at a maximum aneurysm diameter of 5.2 cm
in females. (Dalman et al.,2006)
The digit ratio is the ratio of the lengths of different
digits or fingers typically measured from the midpoint of
bottom crease where the finger joins the hand to the tip
of the finger . (Ecker ,2006)
It has been suggested by some scientists that the ratio
of two digits in particular, the 2nd (index finger) and 4th
(ring finger), is affected by exposure to androgens e.g.
testosterone while in the uterus and that this 2D:4D ratio
can be considered a crude measure for prenatal
androgen exposure, with lower 2D:4D ratios pointing to
higher androgen exposure. (Ecker ,2006)
The 2D:4D ratio is calculated by dividing the length of
the index finger of the right hand by the length of the ring
finger. A longer index finger will result in a ratio higher
than 1, while a longer ring finger will result in a ratio of
less than 1. (Hönekopp et al.,2007)
The 2D:4D digit ratio is sexually dimorphic: while the
second digit is typically shorter in both females and
males, the difference between the lengths of the two
digits is greater in males than females. (Hönekopp et
al.,2007)
A number of studies have shown a correlation
between the 2D:4D digit ratio and various physical and
behavioral traits. (Hönekopp et al.,2007)Digital ration is not studied previously in relation to
AAA or other vascular diseases. However, Manning et al
found 2D:4D, a putative correlate of prenatal
testosterone, is quite strongly predictive of performance
in endurance running in both men and women and based
on that speculated that the relationship may arise
because prenatal testosterone has an organizing effect
on the vascular system (Manning et al.,2007).
While screening for these cohort groups from Sweden
and Egypt, it is interesting to measure 2D:4D to
investigate the potential link between 2D:4D ration and
AAA and to investigate ethnic susceptibility to AAA in
relation to 2D:4D. Thus, exploring the possibility of future
use of 2D:4D as a predictive factor to AAA (Manning et
al.,2007).