PRESENTATION AND PATTERNS OF AORTIC-ANEURYSMS IN YOUNG-PATIENTS

Purpose: Although aortic aneurysm (AA) is primarily a disease of older age groups, younger (<51 years) patients infrequently are admitted re quiring AA surgery. We sought to compare the characteristics of these patients with those of a randomly selected group of older patients wit h AA. Methods: We identified 26 patients with AA (group I) under age 5 1 (mean age 44.8) treated surgically between 1977 and 1993, after excl uding patients with acute aortic dissection, traumatic pseudoaneurysms , and ascending or arch aneurysms, and compared them with 75 randomly selected patients with AA between the ages of 65 and 75 (mean age 70.3 ) who were surgically treated during the same time period (group II). Results: Prevalence of hypertension, diabetes, coexisting heart, kidne y, or occlusive peripheral vascular disease was similar between the tw o groups, and familial aneurysm rates and sex distribution did not dif fer significantly. More patients in group I had symptoms at the time o f presentation (46% vs 6.7%,p < 0.001), and they also had larger AAs ( 6.9 cm vs 6.0 cm, p = 0.01). Definable causes of aneurysmal disease, s uch as Takayasu's, Cogan's, and Marfan syndromes, were more common amo ng the young patients (23% vs 0%, p = 0.01), but most (77%) young pati ents did not have an identifiable syndrome associated with their aneur ysm disease. Group I had a marked shift toward proximal aneurysms, def ined as involvement of juxtarenal suprarenal, or thoracoabdominal aort a (46% vs 18% in group II, p < 0.01). This difference persisted even w hen aneurysms associated with the above syndromes were excluded from c onsideration (p = 0.02). Cigarette smoking was much more common among the young patients (83% vs 51% in group II,p < 0.01). Smoking in group II was associated with more extensive aneurysm disease (p = 0.04). Co nclusions: Aneurysmal disease presenting in the young adult is more li kely to be symptomatic and associated with more proximal aortic involv ement than aneurysmal disease in older patients. Smoking appears to pl ay an important role in the pathogenesis of aneurysmal disease in the young patient and was associated in our study with more proximal aneur ysms among older patients. A subgroup of patients at risk for early an d aggressive aneurysm disease is suggested by these data.