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]

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.

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.

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:

References

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