• E O Matthews, S E Rowbotham, J V Moxon, R E Jones, M Vega de Ceniga, and J Golledge.
• Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Queensland, Australia.
• Br J Surg. 2017 Dec 1; 104 (13): 1765-1774.

BackgroundThe role of atherosclerosis in the pathogenesis of abdominal aortic aneurysm (AAA) is controversial. Atherosclerosis-associated peripheral artery disease (PAD) has been reported to be a risk factor for AAA in population screening studies; its relationship with AAA growth is controversial.MethodsA systematic search of MEDLINE, Scopus, CINAHL and the Cochrane Central Register of Controlled Trials was conducted in April 2016 and repeated in January 2017. Databases were screened for studies reporting AAA growth rates in patients with, and without PAD. The included studies underwent quality assessment and, where possible, were included in the meta-analysis. A subgroup analysis was performed, including only studies that adjusted for confounding factors.ResultsSeventeen studies, including a total of 4873 patients, met the review entry criteria. Data from 15 studies were included in the meta-analysis. There was marked heterogeneity in study design, methodology and statistical analyses used. In the main analysis, PAD was associated with reduced AAA growth (mean difference - 0·13, 95 per cent c.i. -0·27 to -0·00; P = 0·04). However, statistical significance was not maintained in sensitivity analysis. In a subanalysis that included only data adjusted for other risk factors, no significant association between PAD and AAA growth was found (mean difference -0·11, -0·23 to 0·00; P = 0·05).ConclusionThis systematic review suggests that currently reported studies demonstrate no robust and consistent association between PAD and reduced AAA growth.© 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

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