OUTCOME AND EXPANSION RATE OF 57 THORACOABDOMINAL AORTIC-ANEURYSMS MANAGED NONOPERATIVELY

BACKGROUND: The prognosis of thoracoabdominal aortic aneurysms (TAAAs) managed nonoperatively is unknown. PATIENTS AND METHODS: TO determine the risk of rupture and survival, we retrospectively reviewed the cli nical course and computed tomographic data of 57 patients who were eva luated for degenerative, nondissecting TAAAs. Nonoperative management was decided initially for all patients. Data on aneurysm expansion rat e were available in 29 patients who underwent 2 or more scans, Follow- up was complete in 52 (91%) patients and averaged 37 months (range 1 t o 82). RESULTS: Thirty-four of the 57 (60%) patients died during follo w-up, including 3 of 15 patients who underwent subsequent repair of th eir aneurysm, Two- and 5-year survival rates for the entire group were 69% and 39%, with repair-free survival rates of 52% and 17%, respecti vely, Eight (14%) aneurysms ruptured, accounting for 24% (8/34) of the deaths, Two- and 4-year risks of rupture were 12% and 32%, respective ly The median expansion rate was 0.2 cm/y and was greater in patients with chronic obstructive pulmonary disease (P <0.05). All ruptured ane urysms were >5 cm in diameter. Aneurysms with a diameter >5 cm at diag nosis had a higher rupture rate than those with a diameter less than o r equal to 5 cm (P <0.05), Expansion rate did not predict rupture. CON CLUSIONS: Mortality of patients with TAAAs preselected for nonoperativ e management is high, with an overall survival rate of 39% and repair- free survival rate of only 17% at 5 years. Expansion rate of TAAAs (0. 2 cm/y) is similar to that of abdominal aortic aneurysms. Our data sup port nonoperative management for patients with TAAAs <5 cm in diameter , hut confirm the increased rate of rupture for aneurysms >5 cm.