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Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture
W Darrin Clouse1, John W Hallett, Hartzell V Schaff
1Division of Vascular Surgery, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clinic Proceedings
|February 13, 2004
Summary
Acute aortic dissection (AAD) and thoracic aortic aneurysm (TAA) rupture occur with similar frequency. Survival for AAD has improved significantly, suggesting advances in diagnosis and treatment are effective.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Epidemiology
Background:
- Acute aortic dissection (AAD) is often considered the most common aortic catastrophe.
- Previous population-based data on AAD incidence and outcomes require updated analysis.
Purpose of the Study:
- To determine the incidence of AAD and thoracic aortic aneurysm (TAA) rupture.
- To evaluate operative intervention rates and long-term survival for AAD.
- To compare these findings with historical and other population-based studies.
Main Methods:
- Retrospective population-based study in Olmsted County, Minnesota (1980-1994).
- Identified patients with clinical diagnosis of AAD and determined incidence of TAA rupture.
- Analyzed operative intervention rates, 30-day case fatality, and long-term survival for AAD.
Main Results:
- AAD and TAA rupture occurred with similar annual incidences (3.5 per 100,000 persons).
- 85% of AAD cases involved the ascending aorta.
- 30-day case fatality for operated AAD was 9%; median survival for all AAD patients was 3 days.
- Overall 5-year survival for AAD improved to 32% (vs. 5% historically).
Conclusions:
- AAD and ruptured degenerative TAA occur with similar frequency, less commonly than ruptured abdominal aortic aneurysm (AAA).
- Despite diagnostic and management challenges, recent advances are improving long-term survival in AAD.
- Timely recognition and management remain critical for improving AAD outcomes.