Clinical Research
Female and Elderly Abdominal Aortic Aneurysm Patients More Commonly Have Concurrent Thoracic Aortic Aneurysm

https://doi.org/10.1016/j.avsg.2012.01.023Get rights and content

Background

A recent report unexpectedly revealed that one-fourth of abdominal aortic aneurysm (AAA) patients also have an aneurysm in the thoracic aorta (TAA). It remains to be investigated which AAA patients have a higher risk of also developing TAAs. The aim of this study was to identify possible differences in the risk factor profile in AAA patients with or without a TAA.

Methods

All AAA patients attending an outpatient clinic and investigated using an abdominal and thoracic computed tomography scan were included (n = 354). Image analysis and hospital chart review were conducted. The association between comorbidity and TAA was estimated by logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs). Gender-specific and neutral criteria were used. Validation of excluded patients was performed.

Results

Ninety-four (27%) of 354 AAA patients had a concurrent descending TAA (AAA/TAA). AAA/TAA patients were older than AAA patients (76 vs. 73 years). More women were identified in the AAA/TAA group (39% vs. 16%, P < 0.001). In the univariate logistic regression model, female gender (OR: 3.3, 95% CI: 1.9–5.6), hypertension (OR: 1.8, 95% CI: 1.1–3.0), and age (70–79 years—OR: 2.4, 95% CI: 1.3–4.6; 80–89 years—OR: 3.0, 95% CI: 1.5–6.0) were associated with concurrent TAA. In the multivariate model, only female gender and age were associated with TAA.

Conclusions

AAA patients, in general, should be offered examination of the thoracic aorta, and special attention needs to be paid to female AAA patients and AAA patients at high age, if the AAA patient is considered operable. Surveillance of AAA patients must improve to enhance identification of the large group of patients who have developed, or will develop, TAAs. Future strategies will, of course, address pathophysiological aspects of aneurysmal development in the thoracic and infrarenal aorta.

Introduction

The prevalence of thoracic aortic aneurysms (TAAs) in patients with abdominal aortic aneurysms (AAAs) has been quite unknown. A recent descriptive analysis from our group unexpectedly showed that one-fourth of AAA patients also have a TAA.1 However, this study did not analyze ongoing medications or comorbidities, which theoretically could influence the development and growth of aneurysms. Which patients are at high risk of developing concurrent aneurysms is still unknown.

The risk factors commonly found in patients with descending TAAs are to some extent similar to those found in AAA patients.2, 3, 4 It is not known whether certain risk factors could indicate a higher risk to develop concurrent aneurysms in the descending thoracic and infrarenal aortic segments, compared with only one location. One major obstacle in the TAA analysis is the lack of validated and established definitions of disease for women and men in clinical practice.5, 6, 7, 8

An increased awareness among physicians to identify individuals at risk of developing aneurysms in different locations is essential. Improved anesthetic, surgical, and endovascular techniques may have altered treatment indication toward more liberal aneurysm size limits for elective and emergency repair of TAAs and AAAs.9, 10, 11, 12, 13, 14

It remains to be investigated whether AAA patients with a certain risk factor profile constitute a patient group at high risk of developing an aneurysm in the thoracic aorta. The aim of the present study was to investigate comorbidities and ongoing medications in patients with concurrent AAAs and TAAs, compared with those with only infrarenal AAAs, to detect possible clinical predictors for development of aneurysms in the thoracic segment.

Section snippets

Patient and Data Collection

Data for consecutive patients with an infrarenal AAA, defined as an aortic diameter ≥30 mm, attending the outpatient clinic at Karolinska University Hospital, Stockholm, Sweden, from January 1, 2004, to December 31, 2008, were analyzed (n = 1055). The catchment area covers approximately 1.5 million inhabitants, the majority being Caucasians. Patients were excluded if diagnosed with pathology in the thoracic aorta (e.g., dissections or aneurysms), those who had undergone previous intervention in

Results

Of the 354 AAA patients included, 94 (27%) had an aneurysm in the descending thoracic aorta. AAA patients with a concurrent TAA were older than those without a TAA (mean age: 76 vs. 73 years; Table I). The gender distribution differed between patient groups, with a higher proportion of female patients in the group with both AAAs and TAAs compared with the group with only AAAs. Hypertension was more prevalent in patients with concurrent aneurysms (AAAs and TAAs) compared with those with only

Discussion

We recently reported that one of four patients with AAAs also suffers from an undiagnosed TAA.1 The lack of knowledge regarding the possible underlying mechanisms for this unexpected large proportion of patients with TAAs and AAAs initiated this report.

Patients with both AAAs and TAAs were older and more likely to be female than those with only AAAs. Female gender is an independent risk factor, and the higher mean age of women in the study cohort does not explain their higher risk (Table III).

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