Thoracic aortic aneurysm classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Salih, MD. [2]
Overview
In 1986, Crawford described the first TAAA classification scheme based on the anatomic extent of the aneurysm. Type I involves most of the descending thoracic aorta from the origin of the left subclavian to the suprarenal abdominal aorta. Type II is the most extensive, extending from the subclavian to the aortoiliac bifurcation. Type III involves the distal thoracic aorta to the aortoiliac bifurcation. Type IV TAAAs are limited to the abdominal aorta below the diaphragm. Safi’s group modified this scheme by adding Type V, which extends from the distal thoracic aorta including the celiac and superior mesenteric origins but not the renal arteries.There are two major types of aneurysm morphology: fusiform, which is uniform in shape with symmetrical dilatation that involves the entire circumference of the aortic wall, and saccular, which is more localized and appears as an outpouching of only a portion of the aortic wall. Saccular aneurysms may be a manifestation of plaque hemorrhage and aortic ulceration or aortic wall infection and appear to have an increased risk for rupture.
Classification
- Thoracic aortic aneurysms are classified by location within the aorta, extent of aortic involvement, and morphology[1].
- These categories help to stratify the approach to surgical management.
- Aneurysms of the thoracic aorta can be classified into four general anatomic categories[2]:
- Ascending aortic aneurysms arise anywhere from the aortic valve to the innominate artery (60 percent)
- Aortic arch aneurysms include any thoracic aneurysm that involves the brachiocephalic vessels (10 percent)
- Descending aortic aneurysms are those distal to the left subclavian artery (40 percent)
- Thoracoabdominal aneurysms (10 percent)aneurysms that affect the thoracic and abdominal aorta (ie, thoracoabdominal aneurysms) have been classified according to Crawford and modified by Safi[3][4]:
- Type I arises from above the sixth intercostal space, usually near the left subclavian artery, and extends to include the origins of the celiac axis and superior mesenteric arteries. Although the renal arteries can also be involved, the aneurysm does not extend into the infrarenal aortic segment.
- Type II aneurysm also arises above the sixth intercostal space and may include the ascending aorta, but extends distal to include the infrarenal aortic segment, often to the level of the aortic bifurcation.
- Type III aneurysm arises in the distal half of the descending thoracic aorta, below the sixth intercostal space, and extends into the abdominal aorta.
- Type IV aneurysm generally involves the entire abdominal aorta from the level of the diaphragm to the aortic bifurcation.
- Type V aneurysm arises in the distal half of the descending thoracic aorta, below the sixth intercostal space, and extends into the abdominal aorta, but is limited to the visceral segment.
- There are two major types of aneurysm morphology[5][6];
- fusiform, which is uniform in shape with symmetrical dilatation that involves the entire circumference of the aortic wall.
- saccular, which is more localized and appears as an outpouching of only a portion of the aortic wall. Saccular aneurysms may be a manifestation of plaque hemorrhage and aortic ulceration or aortic wall infection and appear to have an increased risk for rupture.
References
- ↑ Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM (April 2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.
- ↑ Isselbacher EM (February 2005). "Thoracic and abdominal aortic aneurysms". Circulation. 111 (6): 816–28. doi:10.1161/01.CIR.0000154569.08857.7A. PMID 15710776.
- ↑ Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ (February 1993). "Experience with 1509 patients undergoing thoracoabdominal aortic operations". J. Vasc. Surg. 17 (2): 357–68, discussion 368–70. PMID 8433431.
- ↑ Safi HJ, Winnerkvist A, Miller CC, Iliopoulos DC, Reardon MJ, Espada R, Baldwin JC (October 1998). "Effect of extended cross-clamp time during thoracoabdominal aortic aneurysm repair". Ann. Thorac. Surg. 66 (4): 1204–9. doi:10.1016/s0003-4975(98)00781-4. PMID 9800807.
- ↑ Ohki M (2012). "Thoracic Saccular Aortic Aneurysm Presenting with Recurrent Laryngeal Nerve Palsy prior to Aneurysm Rupture: A Prodrome of Thoracic Aneurysm Rupture?". Case Rep Otolaryngol. 2012: 367873. doi:10.1155/2012/367873. PMC 3420719. PMID 22953111.
- ↑ Nathan DP, Xu C, Pouch AM, Chandran KB, Desjardins B, Gorman JH, Fairman RM, Gorman RC, Jackson BM (November 2011). "Increased wall stress of saccular versus fusiform aneurysms of the descending thoracic aorta". Ann Vasc Surg. 25 (8): 1129–37. doi:10.1016/j.avsg.2011.07.008. PMID 22023944.