Outcomes Following Non-operative Management of Thoracic and Thoracoabdominal Aneurysms

Background Surgical decision making remains difficult in several patients with aneurysmal disease of the descending thoracic (DT) or thoracoabdominal (TA) aorta. Despite previous studies that have investigated aneurysms treated non-operatively using a prospective growth analysis, completeness and accuracy of follow-up were inconsistent. We aim to describe the survival and freedom from adverse aortic events in patients with DT and TA who did not undergo operative repair. Methods This is a single-center retrospective analysis of all patients with either a descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion who were treated non-operatively from April 2002 to December 2016. We studied patients who did not undergo operative repair of descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion. Primary end points were overall survival and freedom from aortic-related mortality (ARM). Results Of the 315 patients diagnosed with DT or TA disease, 56 (18%) did not undergo surgical repair. Mean aneurysm diameter was 65mm +/- 15 (range 50-120; IQR 5.4-7.15). Extent of the aortic aneurysms was DT in 36 (11%) patients and TA in 20 (6%). Median duration of follow-up was 12months (range 1-108; IQR 3-36). Over the course of the study, 41 (73%) patients died for an overall survival rate of 53% +/- 7 at 1year (95% CI 40-65) and 23%+/- 7 at 3year (95% CI 17-42.5). Aortic-related mortality was 27% (n=15), significantly higher in patients with aneurysms >= 60mm [n=13, (39%) vs. n=2, (9%); P=0.025; OR=5.04]. Overall, estimated freedom from ARM was 81%+/- 5.5 at 1year (95% CI 68-89) and 66.5%+/- 9 at 3year (95% CI 48-81). Only TA extent was independently associated with freedom from ARM during the follow-up (P=0.005; HR: 5.74; 95% CI 1.711-19.729). Conclusions Thoracoabdominal extent of the aneurysmal aortic disease is the most important predictor of ARM in unrepaired DT or TA aortic diseases. Mortality from aortic-related events was significantly more premature than mortality from non-aortic-related mortality.