Liu Heng, de Bruin Jorg L, IJpma Arne S, Castelijns C G M, Heijsman Daphne, Hussain Burhan, Bouwens Elke, Brüggenwirth H T, Roos-Hesselink Jolien W, Raa Sander Ten, van Tongeren O L R M, Verhagen Hence J M, van Beusekom Heleen M M, Majoor-Krakauer Danielle
Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands.
Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands.
J Vasc Surg. 2025 Apr 7. doi: 10.1016/j.jvs.2025.03.477.
Thoracic aortic aneurysms (TAAs) occur more frequently in abdominal aortic aneurysm (AAA) patients than in the general population. The aim of the study was to investigate which AAA patients have an increased risk of developing TAA or thoraco-abdominal aortic aneurysm (TAAA), and if sex, genetic susceptibility for aneurysms, or conventional cardiovascular risk factors affect this risk.
Repeated computed tomography scans from consecutively diagnosed AAA patients were evaluated retrospectively to determine the prevalence, sequence, and location of multiple aortic aneurysms. Effects of sex, genetic predisposition for aneurysms (familial aneurysm, the presence of [likely] pathogenic variants in known aneurysm genes), and cardiovascular risk factors (age, smoking, hypertension, diabetes mellitus, and hypercholesterolemia) on the risk for TAA were analyzed. Five-year survival was used to evaluate the impact of having thoracic aneurysms on survival of AAA patients.
On the first computed tomography scan, 10.8% of AAA patients had a TAA. During follow-up, an additional 5.1% of the AAA patients developed TAA and 2.4% developed TAAA. Female patients had a two-fold increase in risk for TAA, in particular for aneurysms of the descending aorta. A two-fold increase in risk for ascending TAA was observed in AAA patients reporting familial aneurysms. The 5-year survival of female TAAA patients was lower than that of AAA patients, independent of having a TAA.
Female AAA patients had a two-fold increase in risk for TAA, particularly in the descending aorta. Familial AAA patients had a two-fold increase in aneurysm risk for ascending aortic aneurysms. TAAA patients had a lower survival compared with TAA or AAA patients, specifically among female TAAA patients. TAA and TAAA developed during follow-up. Therefore, follow-up imaging of both the ascending and descending aorta after diagnosis of AAA may improve early detection of multiple aneurysms.
与普通人群相比，胸主动脉瘤（TAA）在腹主动脉瘤（AAA）患者中更为常见。本研究的目的是调查哪些AAA患者发生TAA或胸腹主动脉瘤（TAAA）的风险增加，以及性别、动脉瘤的遗传易感性或传统心血管危险因素是否会影响这一风险。
对连续诊断的AAA患者的重复计算机断层扫描进行回顾性评估，以确定多发性主动脉瘤的患病率、发生顺序和位置。分析性别、动脉瘤的遗传易感性（家族性动脉瘤、已知动脉瘤基因中[可能]致病变异的存在）和心血管危险因素（年龄、吸烟、高血压、糖尿病和高胆固醇血症）对TAA风险的影响。采用五年生存率评估胸主动脉瘤对AAA患者生存的影响。
在首次计算机断层扫描时，10.8%的AAA患者患有TAA。在随访期间，另外5.1%的AAA患者发生了TAA，2.4%的患者发生了TAAA。女性患者发生TAA的风险增加两倍，尤其是降主动脉瘤。报告有家族性动脉瘤的AAA患者升主动脉瘤的风险增加两倍。女性TAAA患者的五年生存率低于AAA患者，与是否患有TAA无关。
女性AAA患者发生TAA的风险增加两倍，尤其是降主动脉。家族性AAA患者升主动脉瘤的风险增加两倍。与TAA或AAA患者相比，TAAA患者的生存率较低，尤其是女性TAAA患者。TAA和TAAA在随访期间发生。因此，AAA诊断后对升主动脉和降主动脉进行随访成像可能有助于早期发现多发性动脉瘤。
