Multimodality serial follow-up of thoracic aortic aneurysms

Abstract

We identified 520 diagnostic imaging tests (MRI, CT, ECHO) performed in 205 patients (79 female 126 male) (age 20–94, mean 63.9) being followed at Yale-New Haven hospital for progression in size of their thoracic aortas. Estimated growth rates did not differ significantly across imaging modalities.

The average maximal size of the thoracic aorta was 5.3 cm (range 3.5–10.0). Mean maximal size was 5.3 cm in the 326 imaging studies without dissections. Mean size at time of dissection (N = 22) was 6.2 cm, and a time of rupture (N = 7), 6.5 cm.

Survival at 3 and 5 years was 66% and 45%, respectively. Subjects having aortic dissection had lower survival (58% 3 year; 15% 5 year) than the non-dissected cohort (70% 3 year; 60% 5 year).

Mean estimated growth rate on 53 patients followed serially for aortic expansion was 0.1 cm/yr. Stepwise multivariate risk factor analysis indicated that large (> = 6.0 cm) aneurysms grew significantly more rapidly (p< 0.02), that aneurysms located in the ascending aorta or arch grew more slowly than aneurysms located in the descending thoracic or thoraco-abdominal aorta (p< 0.04), and that aneurysms grew more rapidly among male patients than among females (p< 0.02).

We conclude that (1) the overall growth rate in thoracic aorta aneurysms is 0.1 cm/yr. (2) Large aneurysms grow more rapidly than smaller ones. (3) Aneurysms grow more slowly in the ascending thoracic aorta or arch than on other locations of the thoracic aorta. (4) Aneurysms appear to grow somewhat more rapidly among male patients than among females. (5) One-half of aortic dissections and ruptures occur at sizes <6.0 cm. (6) Long-term survival prospects are less for patients having dissected aortas. (7) 5.0–5.5 cm is an appropriate criterion for surgical intervention in the thoracic aorta to prevent rupture or dissection.