Thoracic aortic aneurysm natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2] Mohammad Salih, MD.
Overview
Thoracic aortic aneurysms typically expand slowly at a rate of approximately 0.1-0.2 cm/year. Aortic dissection and aortic rupture are the two most feared complications of an aortic aneurysm. The five-year survival of patients with a thoracic aortic aneurysm is 56%. The following are associated with a poorer prognosis: the presence of diastolic dysfunction; trauma as a cause of the aneurysm; the presence of coronary artery disease and the presence of carotid artery disease.
Natural History
Thoracic aneurysms enlarge at a more rapid rate than abdominal aneurysms (0.42 vs 0.28 cm/yr), with aneurysms of the aortic arch growing at ~ 0.56 cm/yr. Aneurysms that are 5-6 cm in diameter have a faster rate of growth and a greater tendency to rupture than smaller ones.[1]
Complications
Dissection
- Aortic dissection and aortic rupture are the two most feared complications of an aortic aneurysm. Patients who have a prior dissection as a cause of an aneurysm are at increased risk of rapid expansion and re-dissection of the aneurysm.[2][3][4][5][6]
- Aortic regurgitation
- Congestive heart failure
Shown below is the annual risk of thoracic aortic rupture, dissection or death for different diameters of thoracic aortic aneurysms. This draft forms the basis for performing surgery when the aorta is 5.0 to 6 cm in diameter depending upon whether the patient has Marfan syndrome or not.
Prognosis
The five-year survival of patients with a thoracic aortic aneurysm is 56%. The principal causes of death due to thoracic aneurysmal disease are dissection and rupture. Women face a 6.8 fold higher risk of aortic rupture. Once rupture occurs, the mortality rate is 50–80%. Most deaths in patients with the Marfan syndrome are the result of aortic disease. It is estimated that up to 47,000 people die each year from all types of aortic disease (thoracic and abdominal aortic aneurysms combined).
Factors associated with a worse prognosis are:
- Diastolic dysfunction
- Traumatic aneurysm
- Associated coronary artery disease
- Carotid artery disease
References
- ↑ Gillum RF (November 1995). "Epidemiology of aortic aneurysm in the United States". J Clin Epidemiol. 48 (11): 1289–98. doi:10.1016/0895-4356(95)00045-3. PMID 7490591.
- ↑ Clouse WD, Hallett JW, Schaff HV, Gayari MM, Ilstrup DM, Melton LJ (December 1998). "Improved prognosis of thoracic aortic aneurysms: a population-based study". JAMA. 280 (22): 1926–9. doi:10.1001/jama.280.22.1926. PMID 9851478.
- ↑ Juvonen T, Ergin MA, Galla JD, Lansman SL, Nguyen KH, McCullough JN, Levy D, de Asla RA, Bodian CA, Griepp RB (June 1997). "Prospective study of the natural history of thoracic aortic aneurysms". Ann. Thorac. Surg. 63 (6): 1533–45. doi:10.1016/s0003-4975(97)00414-1. PMID 9205145.
- ↑ Coady MA, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA (June 1999). "Surgical intervention criteria for thoracic aortic aneurysms: a study of growth rates and complications". Ann. Thorac. Surg. 67 (6): 1922–6, discussion 1953–8. doi:10.1016/s0003-4975(99)00431-2. PMID 10391339.
- ↑ Kim JB, Kim K, Lindsay ME, MacGillivray T, Isselbacher EM, Cambria RP, Sundt TM (October 2015). "Risk of rupture or dissection in descending thoracic aortic aneurysm". Circulation. 132 (17): 1620–9. doi:10.1161/CIRCULATIONAHA.114.015177. PMID 26338955.
- ↑ Yiu RS, Cheng SW (May 2016). "Natural history and risk factors for rupture of thoracic aortic arch aneurysms". J. Vasc. Surg. 63 (5): 1189–94. doi:10.1016/j.jvs.2015.12.043. PMID 26926929.