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CC BY-NC-ND 4.0 · Aorta (Stamford) 2023; 11(01): 010-019
DOI: 10.1055/a-2000-7812
Original Research Article

Ascending Aortic Aneurysms <4.5 cm for Nonsyndromic Adults: Very Slow Growth and Low Risk

Loren F. Hiratzka 
1   TriHealth Heart Institute, Cardiothoracic Surgery, Bethesda North Hospital, Cincinnati, Ohio
,
Tiffany Hanlon
1   TriHealth Heart Institute, Cardiothoracic Surgery, Bethesda North Hospital, Cincinnati, Ohio
,
Katherine Vorpe
2   TriHealth Clinical Training and Testing Center, Bethesda North Hospital, Cincinnati, Ohio
› Author Affiliations Funding This work was funded by Educational Grant from the Bethesda Foundation.
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Abstract

Background Current practice guidelines for patients with thoracic aortic aneurysms (TAAs) recommend 6 to 12-month intervals for surveillance imaging based on growth estimates of 0.10 to 0.42 cm/y gleaned from limited studies which included patients with thoracoabdominal aneurysms, known acute or chronic aortic dissection, and other syndromic and nonsyndromic high-risk conditions (TAA-HRC) associated with high-risk for adverse aortic events and death. Our objective was to determine TAA growth and event-free survival rates for patients with aortic root or midascending diameters <5.0 cm, and without thoracoabdominal aneurysms, acute or chronic aortic dissection or higher risk syndromic or nonsyndromic conditions (TAA-NoHRC).

Methods A retrospective review of patient records and imaging studies were done. Aortic diameter measurements were all performed by the lead author.

Results For 197 TAA-NoHRC found incidentally during chest imaging, with 616 chest imaging studies over 868 patient-years, the mean aortic root and midascending aortic growth rates were 0.018 and 0.022 cm/y, respectively. The growth rate was significantly lower for aneurysms initially measured at <4.5 cm versus ≥ 4.5 cm at both the aortic root (0.011 vs. 0.068 cm/y) and midascending aorta (0.013 vs. 0.043 cm/y). Survival free from adverse aortic events (dissection, rupture, and surgery) or death at 5 years was 99.5%.

Conclusion Adult TAA-NoHRC patients with initial aortic root and/or ascending aortic diameters <5.0 cm, and particularly <4.5 cm, have very low aortic growth, and adverse event rates which may permit longer intervals between surveillance imaging, up to 3 to 5 years, after initial (6–12 months) stability is documented.

Keywords

thoracic aortic aneurysm - aortic dissection - annual chest imaging - aortic diameter growth rate - practice guidelines


Publication History

Received: 25 May 2022

Accepted: 09 December 2022

Accepted Manuscript online:
20 December 2022

Article published online:
27 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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