| Summary: | The thesis which aims at providing a comprehensive study on abdominal aortic aneurysms, in its three main sections, addresses the sequential climacteric issues of: (1) What is the epidemiology of abdominal aortic aneurysms in Scotland? and how proficient are the current results of their management?, (2) What is the current understanding of the aetiology and pathogenesis of this condition? and (3) Can the identification of prognostic risk factors and the development of a prognostic clinical scoring system assist in improving the clinical management of this condition? Recent studies have demonstrated evidence of increased proteolytic activities(elastase and collagenase enzymes) in the tissues of abdominal aortic aneurysms. Biochemical assays of these two enzymes were carried out. The activities were assessed in two groups of patients; one with aneurysmal and the other with occlusive aortas. The results showed that "elastase" was significantly elevated in the aneurysmal group while "collagenase" contrary to other studies was not. The implications of these findings are discussed. The hypothesis of immune mediated aetiology was also tested in this thesis by studying the occurrence of autoimmune complexes in the aneurysmal and occlusive groups and by studying complement activity, anti-smooth muscle and anti-mitochondrial antibodies in the sera of these patients. The findings of these studies did not support an immune mediated mechanism to be participating in the pathogenesis of the disease as indirectly suggested in previous studies. The details and implications of these findings are discussed. Further to my previous work presented for my MSc thesis at Glasgow University and carried out in Glasgow, Scotland, on different clinical risk factors predicting operative outcome, a clinical prognostic scoring system was developed (Glasgow Aneurysm Score). This was based on studying 500 randomly selected aneurysm patients' records. The score predicts operative and postoperative in-hospital mortality in patients with ruptured or intact aneurysms. The clinical application of the score includes guiding discussions on prognosis with patients and their families or with other colleagues involved in the management, like anaesthetists, and when considering patients' transfer between hospitals such as from small peripheral hospitals to vascular centres. This scoring system was further assessed and prospectively tested on 320 consecutive patients. The Score was found to be reliable and accurate in predicting operative mortality and did not require modification.
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