what is the success rate of thoracic aortic aneurysm surgery?
7. National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice. N Engl J Med. Eur J Vasc Endovasc Surg. Brown LC, Powell JT. “It is extremely dangerous to defer the operation while knowing of an aortic aneurysm because aortic aneurysms do not recover. Aortic aneurysms at the site of the repair of coarctation of the aorta: a review of 48 patients. Ann Thorac Surg. Elective surgery to repair an aneurysm has only a 5 percent … Thoracic aortic aneurysms (TAAs) are considered “silent killers” because they seldom produce symptoms but are associated with high morbidity and mortality.1 As many as 22% of people who suffer an acute aortic syndrome die at home before receiving medical attention,2, 3 and among those who reach the hospital alive, 34% die within the first 30 days.2Despite these somber statistics, TAA remains significantly understudied when compared to other cardiovascular or systemic diseases. Bahia et al revealed that AAA patients with appropriate risk factor modification can significantly reduce their long-term mortality.27, Unfortunately, there are no trials that comprehensively analyze the natural history of TAA (like the EVAR 2 trial for AAA). This survival rate was significantly better than the 5-year survival of 19% between 1951 and 1980 ( P <.01). 2006;81:169-177. The present population-based study of primary open thoracic aortic surgery, using data from 1993 to 2010, demonstrated an overall survival rate of 86.6% at 1 year, which declined to 44.7% at 15 years. Learn more about the Chinese Health Initiative. Diehm N, Dick F, Schaffner T, et al. Incidence of descending aortic pathology and evaluation of the impact of thoracic endovascular aortic repair: a population-based study in England and Wales from 1999 to 2010. Data from Yale have described the incidence of rupture and dissection as a function of initial aneurysm size and that the risks of these events increase with greater aneurysm diameter.14 Further analyses revealed that baseline aortic diameter was the only significant risk factor for adverse aortic events, with a hinge point of aortic diameter around 60 mm, while the yearly rate of serious aortic complications increased exponentially from 10% at 6 cm to 43% at 7 cm.14 Based on these findings, the authors suggested the threshold of 5.5 to 6 cm for prophylactic surgical aortic repair. 1994;331:1729-1734. Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture such as aneurysm size, rate of growth, and Monday, March 28, 2016 There are some promising developments, such as molecular imaging and new insights in medical therapy, that may also help in this process when they become available for clinical use. Eighty deaths occurred among the 133 patients with degenerative thoracic aortic aneurysms, for a 5-year survival rate of 56% (95% CI, 48%-66%) compared with an expected survival of 78% ( Figure 3 ). Complications in frail and elderly patients can be the reason for loss of independence, and thus, quality of life should be an important consideration, especially in patients whose aneurysms were not symptomatic before surgery. 2016;103:1626-1633. Karthikesalingam A, Bahia SS, Patterson BO, et al. 4. 27. Makaroun MS, Dillavou ED, Kee ST, et al. 15. Ask the Experts: When and How Do You Survey a Small TAA? Only 5.3% of those with a diameter of 40 to 44 mm achieved the theoretical threshold size (55 mm) within 2 years. 2011;53:1499-1505. Because patients with high rates of growth and large aneurysm size are selected out for surgery, following the natural history of the disease in an unbiased manner is difficult. 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