Surgical Indication for Chronic Aortic Dissection in Descending Thoracic and Thoracoabdominal Aorta.
To address the lack of information about the size of ruptures associated with chronic dissection in the descending and thoracoabdominal aorta, we evaluated the natural history of this pathology.



We analyzed data from 571 patients (mean age, 69.4±11.6 years) with unrepaired chronic aortic dissection in the descending or thoracoabdominal aorta with a maximal aortic diameter of ≥3.5 cm from 2007 to 2014. This was a cross-sectional study. Data on the timing of computed tomographic scan were as follows: for ruptured cases: at the time of rupture; for nonruptured cases: the initial aortic diameter. Patients with connective tissue disorders were excluded. The primary end point was evidence of aortic rupture on computed tomographic images. The median maximal diameter was 4.3 cm (limits, 3.5-9.0 cm) for all aortas and 5.6 cm (n=31; limits, 3.6-8.0 cm) for ruptured aortas. For aortic diameters of 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, 5.5 to 5.9, and 6.0 to 6.4 cm, the incidence of rupture was 0%, 3.3%, 15.3%, 18.8%, and 28.6%, respectively. The risk factors for rupture were absence of hypertension, chronic heart failure, chronic-phase dissection, and Yale index.



The risk of aortic rupture increased with an aortic diameter of ≥5.0 cm in patients with chronic aortic dissection in the descending or thoracoabdominal aorta. We would recommend 5.0 cm as an acceptable size for elective resection of subacute or chronic aortic dissection in the descending or thoracoabdominal aorta.
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Tatsuya
T
Oda
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan. minatoya@ncvc.go.jp.
Kenji
K
Minatoya
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Hiroaki
H
Sasaki
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Hiroshi
H
Tanaka
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Yoshimasa
Y
Seike
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Tatsuya
T
Itonaga
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Yosuke
Y
Inoue
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Masahiro
M
Higashi
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Kunihiro
K
Nishimura
From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Junjiro
J
Kobayashi
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D002908:Chronic Disease; D000072226:Computed Tomography Angiography; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
aortic rupture; dissection; natural history; thoracic aortic aneurysm; thoracoabdominal aortic aneurysm