Thoracic aortic aneurysm: natural history and treatment
Pressler, V.; McNamara, J.J.
Journal of Thoracic and Cardiovascular Surgery 79(4): 489-498
1980
ISSN/ISBN: 0022-5223 PMID: 7359927 Document Number: 160820
In a review of 176 patients with a diagnosis of thoracic aortic aneurysm, the leading cause of death for 135 patients not treated surgically was ruptured aneurysm. Rupture accounted for 37 of 48 deaths (77%) in 59 patients with dissecting aneurysms and 25 and 57 deaths (44%) in 76 patients with arteriosclerotic aneurysms. Dissecting aneurysms which ruptured did so within 3 days of diagnosis or onset of symptoms in 60% of cases. Of dissecting aneurysms, 40% which ruptured did so more than 3 days after diagnosis, and 25% did not rupture until more than 1 mo. after diagnosis. There is a high risk of late rupture. Only 9% of arteriosclerotic aneurysm ruptures occurred within 3 days of diagnosis, and 68% occurred more than 1 mo. after diagnosis. Arteriosclerotic thoracic aneurysms were predominantly located in the descending aorta, originating just distal to the left subclavian artery. Dissecting thoracic aneurysms originated in the ascending and descending aorta, with a slightly higher incidence of origin in the ascending aorta. Dissecting aneurysms produced symptoms referrable to the aneurysm in 78% of cases, whereas only 42% of arteriosclerotic aneurysms caused symptoms. Nineteen patients in the study had elective operations. There were no subsequent ruptures among this group, and the survival rate at 5 yr in this highly selective group was 5 times as great as for all other patients. Dissecting aortic aneurysms are evidently a medical emergency demanding immediate surgical intervention in a majority of patients. Both arteriosclerotic and dissecting aneurysms evidently should be considered for elective operation because of the high risk of late rupture.