Evaluation of the diameter of the proximal descending thoracic aorta with age: implications for thoracic aortic stent grafting.
BACKGROUND
Long-term anatomical changes of the thoracic aorta which may affect long-term outcome of blunt aortic injuries treated with endovascular stent grafts are unknown. The purpose of this study was to examine the natural history of thoracic aortic diameter with progressing age.


METHODS
One thousand consecutive thoracic computed tomographic scans performed for nonthoracic aortic pathology on patients aged 15-99 (mean 59.4) were examined, and thoracic aortic diameter immediately adjacent to the left subclavian artery was measured. Factors possibly influencing diameter, including age by decade of life, race, gender, history of hypertension (HTN), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and tobacco use, were examined. Factors were compared using Student's t-test.


RESULTS
The differences in mean diameters of the thoracic aorta by gender (male=27.1 vs. female=26.0, p=0.87), race (Caucasian=26.6 vs. non-Caucasian=26.3, p=0.10), presence of HTN (yes=25.8 vs. no=24.9, p=0.36), COPD (yes=26.3 vs. no=25.4, p=0.21), DM (yes=26.1 vs. no=25.3, p=0.12), and tobacco use (yes=26.3 vs. no=25.0, p=0.18) were not significant. However, differences in mean diameter increased significantly over time with age. Patients under 40 years old had mean aortic diameters of 22.92 mm compared to 27.09 mm (p<0.001) for patients over 40. The mean aortic isthmus diameter showed an approximately 1cm increase when comparing octogenarians to teenagers.


CONCLUSIONS
The diameter of the aortic isthmus increases substantially with age. These findings suggest that long-term surveillance is warranted for trauma patients with aortic stent grafts, to monitor the natural history and to assess for possible late complications.
Hartley
Michael C
MC
Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA. elangan@ghs.org
Langan
Eugene M
EM
Cull
David L
DL
Taylor
Spence M
SM
Carsten
Christopher G
CG
Blackhurst
Dawn W
DW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D014057:Tomography, X-Ray Computed; D055815:Young Adult