Outcomes Following Non-operative Management of Thoracic and Thoracoabdominal Aneurysms
- 62 Downloads
Surgical decision making remains difficult in several patients with aneurysmal disease of the descending thoracic (DT) or thoracoabdominal (TA) aorta. Despite previous studies that have investigated aneurysms treated non-operatively using a prospective growth analysis, completeness and accuracy of follow-up were inconsistent. We aim to describe the survival and freedom from adverse aortic events in patients with DT and TA who did not undergo operative repair.
This is a single-center retrospective analysis of all patients with either a descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion who were treated non-operatively from April 2002 to December 2016. We studied patients who did not undergo operative repair of descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion. Primary end points were overall survival and freedom from aortic-related mortality (ARM).
Of the 315 patients diagnosed with DT or TA disease, 56 (18%) did not undergo surgical repair. Mean aneurysm diameter was 65 mm ± 15 (range 50–120; IQR 5.4–7.15). Extent of the aortic aneurysms was DT in 36 (11%) patients and TA in 20 (6%). Median duration of follow-up was 12 months (range 1–108; IQR 3–36). Over the course of the study, 41 (73%) patients died for an overall survival rate of 53% ± 7 at 1 year (95% CI 40–65) and 23% ± 7 at 3 year (95% CI 17–42.5). Aortic-related mortality was 27% (n = 15), significantly higher in patients with aneurysms ≥ 60 mm [n = 13, (39%) vs. n = 2, (9%); P = 0.025; OR = 5.04]. Overall, estimated freedom from ARM was 81% ± 5.5 at 1 year (95% CI 68–89) and 66.5% ± 9 at 3 year (95% CI 48–81). Only TA extent was independently associated with freedom from ARM during the follow-up (P = 0.005; HR: 5.74; 95% CI 1.711–19.729).
Thoracoabdominal extent of the aneurysmal aortic disease is the most important predictor of ARM in unrepaired DT or TA aortic diseases. Mortality from aortic-related events was significantly more premature than mortality from non-aortic-related mortality.
- 2.Conrad MF, Ergul EA, Patel VI, Paruchuri V, Kwolek CJ, Cambria RP (2010) Management of diseases of the descending thoracic aorta in the endovascular era: a Medicare population study. Ann Surg 252:603–610Google Scholar
- 7.Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al, 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, Society for Vascular Medicine (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:e266–e369Google Scholar
- 12.Bertges DJ, Goodney PP, Zhao Y, Schanzer A, Nolan BW, Likosky DS et al (2010) Vascular study group of New England. The vascular study group of New England cardiac risk index (VSG-CRI) predicts cardiac complications more accurately than the revised cardiac risk index in vascular surgery patients. J Vasc Surg 52:674–683CrossRefGoogle Scholar
- 14.Ammar CP, Larion S, Ahanchi SS, Lavingia KS, Dexter DJ, Panneton JM (2016) Anatomic severity grading score for primary descending thoracic aneurysms predicts procedural difficulty and aortic-related reinterventions after thoracic endovascular aortic repair. J Vasc Surg 64:912–920CrossRefGoogle Scholar
- 19.Pitt MP, Bonser RS (1997) The natural history of thoracic aortic aneurysm disease: an overview. J Card Surg 12(2 Suppl):270–278Google Scholar
- 27.DeBakey ME, McCollum CH, Crawford ES, Morris GC Jr, Howell J, Noon GP et al (1982) Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery 92:1118–1134Google Scholar
- 32.Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H et al (2014) ESC committee for practice guidelines. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J 35:2873–2926CrossRefGoogle Scholar