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Improved prognosis of thoracic aortic aneurysms: a population-based study
W D Clouse1, J W Hallett, H V Schaff
1Division of Vascular Surgery, Mayo Clinic and Mayo Medical School, Rochester, Minn 55905, USA.
JAMA
|December 16, 1998
Summary
Improved medical therapies and surgical techniques have significantly enhanced survival for thoracic aortic aneurysms. Elderly women are increasingly affected and represent the majority of rupture cases, highlighting a shift in patient demographics.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Geriatric Medicine
Background:
- Thoracic aortic aneurysms (TAAs) are increasingly identified incidentally, posing management challenges, particularly in the elderly population.
- The prognosis for TAAs has historically been considered poor, necessitating updated assessments with advancements in care.
Purpose of the Study:
- To evaluate changes in TAA prognosis due to improved medical therapies and surgical techniques.
- To compare current TAA incidence, rupture risk, and survival rates with historical data.
Main Methods:
- A population-based cohort study comparing patients diagnosed between 1980-1994 with a cohort from 1951-1980.
- Analysis included incidence, cumulative rupture risk, rupture risk by aneurysm size, and survival rates.
- Data were collected from Olmsted County, Minnesota residents.
Main Results:
- TAA incidence increased over threefold from 1951-1980 to 1980-1994 (10.4 per 100,000 person-years).
- Women constituted 51% of cases and 79% of ruptures, often diagnosed at older ages (mean 75.9 years) than men (mean 62.8 years).
- Five-year survival improved significantly from 19% to 56%, with rupture risk increasing with aneurysm size (31% for ≥6 cm).
Conclusions:
- Elderly women are a growing demographic for TAAs and are disproportionately affected by rupture.
- Significant improvements in overall survival for thoracic aortic aneurysms have been observed in recent years.