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Outcome and expansion rate of 57 thoracoabdominal aortic aneurysms managed nonoperatively
R A Cambria1, P Gloviczki, A W Stanson
1Division of Vascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Background:
The prognosis of thoracoabdominal aortic aneurysms (TAAAs) managed nonoperatively is unknown.
Patients And Methods:
To determine the risk of rupture and survival, we retrospectively reviewed the clinical course and computed tomographic data of 57 patients who were evaluated for degenerative, nondissecting TAAAs. Nonoperative management was decided initially for all patients. Data of aneurysm expansion rate were available in 29 patients who underwent 2 or more scans. Follow-up was complete in 52 (91%) patients and averaged 37 months (range 1 to 82).
Results:
Thirty-four of the 57 (60%) patients died during follow-up, including 3 of 15 patients who underwent subsequent repair of their aneurysm. Two- and 5-year survival rates for the entire group were 69% and 39%, with repair-free survival rates of 52% and 17%, respectively. Eight (14%) aneurysms ruptured, accounting for 24% (8/34) of the deaths. Two- and 4-year risks of rupture were 12% and 32%, respectively. The median expansion rate was 0.2 cm/y and was greater in patients with chronic obstructive pulmonary disease (P < 0.05). All ruptured aneurysms were > 5 cm in diameter. Aneurysms with a diameter > 5 cm at diagnosis had a higher rupture rate than those with a diameter < or = 5 cm (P < 0.05). Expansion rate did not predict rupture.
Conclusions:
Mortality of patients with TAAAs preselected for nonoperative management is high, with an overall survival rate of 39% and repair-free survival rate of only 17% at 5 years. Expansion rate of TAAAs (0.2 cm/y) is similar to that of abdominal aortic aneurysms. Our data that support nonoperative management for patients with TAAAs < 5 cm in diameter, but confirm the increase rate of rupture for aneurysms > 5 cm.