Elefteriades John A
Yale University School of Medicine, New Haven, Connecticut, USA.
Ann Thorac Surg. 2002 Nov;74(5):S1877-80; discussion S1892-8. doi: 10.1016/s0003-4975(02)04147-4.
The natural history of thoracic aortic aneurysm is incompletely understood. Over the last 10 years, at Yale University we have maintained a large computerized database of patients with thoracic aortic aneurysms and dissections. Analysis of this database has permitted insight into fundamental issues of natural behavior of the aorta and development of criteria for surgical intervention.
Specialized statistical methods were applied to the prospectively accumulated database of 1600 patients with thoracic aneurysm and dissection, which includes 3000 serial imaging studies and 3000 patient years of follow-up.
Growth rate: the aneurysmal thoracic aorta grows at an average rate of 0.10 cm per year (0.07 for ascending and 0.19 for descending). Critical sizes: hinge points for natural complications of aortic aneurysm (rupture or dissection) were found at 6.0 cm for the ascending aorta and 7.0 cm for the descending. By the time a patient achieved these critical dimensions the likelihood of rupture or dissection was 31% for the ascending and 43% for the descending aorta. Yearly event rates: a patient with an aorta that has reached 6 cm maximal diameter faces the following yearly rates of devastating adverse events: rupture (3.6%), dissection (3.7%), death (10.8%), rupture, dissection, or death (14.1%). Surgical risks: risk of death from aortic surgery for thoracic aortic aneurysm was 2.5% for the ascending and arch and 8% for the descending and thoracoabdominal aorta. Genetic analysis: family pedigrees confirm that 21% of probands with thoracic aortic aneurysm have first-order family members with arterial aneurysm.
In risk/benefit analysis the accumulated data strongly support a policy of preemptive surgical extirpation of the asymptomatic aneurysmal thoracic aorta to prevent rupture and dissection. We recommend intervention for the ascending aorta at 5.5 cm and for the descending aorta at 6.5 cm. For Marfan's disease or familial thoracic aortic aneurysm, we recommend earlier intervention at 5.0 cm for the ascending and 6.0 cm for the descending aorta. Symptomatic aneurysms must be resected regardless of size. Family members should be evaluated.
胸主动脉瘤的自然病程尚未完全明了。在过去10年中，我们在耶鲁大学建立了一个大型的胸主动脉瘤和夹层患者计算机数据库。对该数据库的分析有助于深入了解主动脉自然行为的基本问题以及制定手术干预标准。
将专门的统计方法应用于前瞻性积累的1600例胸主动脉瘤和夹层患者的数据库，该数据库包括3000次系列影像学研究以及3000患者年的随访资料。
生长速率：胸主动脉瘤平均每年生长0.10厘米（升主动脉为0.07厘米，降主动脉为0.19厘米）。临界尺寸：发现升主动脉瘤自然并发症（破裂或夹层）的转折点为6.0厘米，降主动脉为7.0厘米。当患者达到这些临界尺寸时，升主动脉破裂或夹层的可能性为31%，降主动脉为43%。年事件发生率：最大直径达到6厘米的主动脉患者面临以下每年发生严重不良事件的发生率：破裂（3.6%）、夹层（3.7%）、死亡（10.8%）、破裂、夹层或死亡（14.1%）。手术风险：胸主动脉瘤升主动脉和弓部手术的死亡风险为2.5%，降主动脉和胸腹主动脉为8%。基因分析：家族谱系证实，21%的胸主动脉瘤先证者有患动脉瘤的一级家庭成员。
在风险/效益分析中，积累的数据有力地支持对无症状胸主动脉瘤进行预防性手术切除以预防破裂和夹层的策略。我们建议升主动脉在直径5.5厘米时进行干预，降主动脉在直径6.5厘米时进行干预。对于马凡综合征或家族性胸主动脉瘤，我们建议升主动脉在直径5.0厘米时、降主动脉在直径6.0厘米时进行更早的干预。有症状的动脉瘤无论大小均必须切除。应对家庭成员进行评估。
