Nanette R. Reed, Manju Kalra, Gustavo Oderich, Audra A. Duncan, Thomas C. Bower, Peter Gloviczki
Vascular Surgery, Mayo Clinic Rochester, Rochester, MN.
OBJECTIVES: Thoracic (TAA) and thoracoabdominal aortic aneurysms (TAAA) in young patients are rare. The aim of this study is to evaluate short and long-term outcomes following elective open TAA/TAAA repair in patients <50 years of age
METHODS: Data from 716 consecutive patients undergoing elective TAA/TAAA repair from 1971 to 2011 were analyzed retrospectively. Seventy-two patients were identified. Acute traumatic transection or acute dissection were exclusion criteria.
RESULTS: There were 50 males and 22 females (median age 41 years; range 14-50) with 40 TAA, 2 Crawford Type I, 13 Type II, 14 Type III, and 3 Type IV TAAAs. Twenty-seven (38%) aneurysms were secondary to CTDs; the remainder were degenerative (n=22), post-traumatic (n=13), or the result of a congenital abnormality (n=10). Chronic dissection occurred in 29 patients. Median aneurysm diameter was 6.0 cm. All patients underwent open surgical repair through a left thoracic/thoracoabdominal approach. There were no early postoperative deaths. Major complications developed in 31 (43%), including cardiac (n=6), renal (n=6), paraplegia (n=3), and cerebral ischemia (n=3). Median hospital length of stay was 8 days (range 4-40). Median follow-up was 5.8 years (range 10 days-33 years). Twenty-eight patients (39%) had prior aortic surgery. Eighteen (25%) patients required aortic re-intervention; anastomotic aneurysm repair (n=5), patch aneurysm repair (n=3), ascending or aortic arch repair (n=8), and abdominal aortic repair (n=5). These subsequent repairs were associated with a 22% (4/18) early mortality. On univariate analysis, the incidence of re-intervention was significantly higher in patients with CTD (p=0.01). One, 5 and 10 year survival rates were 95.8%, 91.6%, and 86.1% respectively.
CONCLUSIONS: Young patients who undergo open TAAA repair have favorable short and long-term outcomes. However, a significant proportion require further aortic intervention and imaging surveillance is advised, especially in those with CTD.
AUTHOR DISCLOSURES: T. C. Bower, Nothing to disclose; A. A. Duncan, Nothing to disclose; P. Gloviczki, Nothing to disclose; M. Kalra, Nothing to disclose; G. Oderich, Nothing to disclose; N. R. Reed, Nothing to disclose.
Posted April 2012