Abstract
We investigated the possible relation between thoracic aortic disease events and long-term survival in patients after open Abdominal Aortic Aneurysm (AAA) repair, as well as factors associated with event occurrence. Pre-AAArepair demographic, comorbid, and laboratory variables in 48 patients who had an aortic dissection or thoracic aortic aneurysm up to 25 years after AAA repair were compared with the same variables in 522 patients without such an event. Survival rates at 5 and 10 years were 87% and 53%, respectively, in patients with a thoracic aortic event and 74% and 56% in those without an event (P=.7). Multivariate analysis showed that the risk of thoracic aortic events was increased by a high hemoglobin level, a high Fibrinogen Degradation Product (FDP) level, and a larger AAA diameter. The only factors significantly associated with thoracic aortic events were an AAA diameter of ≥ 55 mm and a high FDP level.
Highlights
The 5-year survival rate after elective open surgical repair of Abdominal Aortic Aneurysm (AAA) is about 70%
The analysis showed that the risk of thoracic aortic event occurrence was increased in patients with a high level of hemoglobin (OR, 1.76; 95% Confidence Interval (CI), 1.14-2.85; P=.0009), a high level of Fibrinogen Degradation Product ([FDP]; Odds Ratio (OR), 1.04; 95% CI, 1.00-1.08; P=.0253), and a larger AAA diameter (OR, 1.22; 95% CI 95%, 1.01-1.48; P=.0366)
In our series of 570 patients who underwent AAA repair, the incidence of thoracic aortic disease events was 6.7% at 5 years and 15.5% at 10 years. These results indicate that thoracic aortic disease may occur in patients who have undergone AAA repair, and they underscore the need for careful, long-term monitoring of such patients, even though, as Cambria et al [13] observed, only 5% of acute dissections occur in the aorta of patients with coexistent or previously treated degenerative aneurysmal disease
Summary
The 5-year survival rate after elective open surgical repair of Abdominal Aortic Aneurysm (AAA) is about 70%. Possible reasons for the relatively high mortality after AAA repair include the advanced age of the patients and the presence at operation or afterward of various comorbid conditions, especially cardiovascular disease, cerebrovascular disease, and cancer [7,8,9]. It is possible that onset of a thoracic aortic disease event such as Thoracic Aortic Aneurysm (TAA) or aortic dissection, the causes of which are similar to those of AAA, may affect the prognosis of a patient in whom AAA repair was performed years earlier [10]. We assessed the effects on survival after AAA repair of onset of TAA or aortic dissection. We investigated risk factors for those events by comparing demographic, comorbid, operative, and laboratory variables in patients in whom an event occurred during a follow-up period of up to 25 years with the same variables in patients who did not have an event
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