title: Ruptured aneurysm of the descending thoracic and thoracoabdominal aorta. Analysis according to size and treatment.
abstract: Acute rupture was confirmed at operation in 117 patients treated for descending thoracic or thoracoabdominal aortic aneurysm. Descending thoracic (n = 80) aortic rupture occurred into lung or esophagus in 8, the pleural cavity in 49, and the mediastinum in 23. Upper abdominal aortic (n = 37) rupture occurred into peritoneal cavity in 3 and into retroperitoneal tissues in 34. Aneurysmal size (range, 5 to 17 cm; median, 8 cm) could be determined retrospectively in 86 patients; 59 (74%) descending thoracic and 27 (73%) abdominal aorta. Size (external diameter) in the former was 8 (14%), 5 to 6 cm; 21 (36%), 6 to 8 cm; 23 (39%), 8 to 10 cm; and 7 (12%) greater than 10 cm. Size at the abdominal site was similar. Thus size was not greater than 10 cm in 52 (88%) (range, 5 to 10 cm), which contradicts opinions that thoracic aneurysms rupture only when size exceeds 10 cm. Twenty-nine patients (25%) were hypotensive (systolic blood pressure less than 100 mmHg), of whom 16 (55%) had cardiac arrest before operation. Associated conditions included advanced age (greater than or equal to 75 years) in 26 (22%), coronary artery disease in 41 (35%), chronic obstructive pulmonary disease in 46 (39%), renal insufficiency in 25 (21%), and cardiovascular disease in 22 (18%). The overall early survival rate (30-day) was 89 of 117 patients (76%); 69% in patients with hypotension, 56% of patients with cardiac arrest, 88% in good-risk patients. Five-year (Kaplan-Meier) survival was 28%. Because elective operation is associated with 92% survival, this should be considered before rupture when aneurysm is 5 cm or larger in good-risk patients, in patients with symptomatic aneurysms, and in most patients with larger aneurysms.
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
authors.forename: E S
authors.initials: ES
authors.lastname: Crawford
authors.forename: K R
authors.initials: KR
authors.lastname: Hess
authors.forename: E S
authors.initials: ES
authors.lastname: Cohen
authors.forename: J S
authors.initials: JS
authors.lastname: Coselli
authors.forename: H J
authors.initials: HJ
authors.lastname: Safi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D001013:Aorta, Thoracic; D001019:Aortic Rupture / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed