Smoking, high blood pressure and peripheral artery disease appear to increase the risk that thoracic aortic aneurysms will rupture, according to a study presented at RSNA 2021.
Liubauskas
Thoracic aortic aneurysm is a weakening in the wall of the aorta in the chest that causes it to bulge outward like a balloon. Untreated aneurysms can develop serious and often deadly dissections, or tears in the inner aortic layer. They may even rupture, which is almost always fatal.
Patients with thoracic aortic aneurysm are currently followed by imaging and treated according to guidelines based primarily on the size and location of the aneurysm.
“The current guidelines for treatment aren’t that well backed by the literature,” said study lead author Rokas Liubauskas, MD, a research fellow at Beth Israel Deaconess Hospital in Boston. “The data we’re seeing suggests that the surgical guidelines could be adjusted.”
Armed with 20 years of CT data from thoracic aortic aneurysm patients, Dr. Liubauskas and colleagues analyzed associations between underlying conditions, or comorbidities, like diabetes and coronary artery disease and the risk of aortic events such as rupture or dissection. The study group included 6,269 patients, median age 71. There were 282 aortic events in the group, for an incidence of 4.5%.
Hypertension, peripheral artery disease and smoking history substantially increased the risk for thoracic aortic aneurysm rupture or dissection, as compared to patients without those comorbidities. For example, the aortic event rate was 7% in people with hypertension, compared to 2% in patients without it.
“Patients with hypertension, peripheral artery disease and smoking suffer with aortic rupture or dissection more often than patients without these comorbidities,” Dr. Liubauskas said.
Comorbidities influenced the risk of aortic events regardless of the initial thoracic aortic aneurysm diameter.
Comorbidities Should be Considered in Follow Up Plans
The results strongly support placing more of a priority on certain comorbidities when making decisions regarding the frequency of imaging follow-up and timing of surgical intervention.
“We don’t think that these comorbidities have enough weight in surgical guidelines,” Dr. Liubauskas said.
Previous research has shown that diabetes is associated with a lower prevalence of thoracic aortic aneurysm. The new study found that people with diabetes who have thoracic aortic aneurysm face a higher risk of dissection or rupture than those without diabetes.
The researchers plan to use their data to build a model that would combine changes in aneurysm diameter measurements with a patient’s comorbidities to predict the likelihood of an aortic rupture or dissection in the future.
“We’re hoping to factor all those things into our model,” Dr. Liubauskas said. “Having as much data as we do and having multiple data points per person is a big plus.”
Access the presentation, “Influence of the Comorbidities on the Dissection and Rupture Rate of the Thoracic Aortic Aneurysm,” (SSVA03) on demand at Meeting.RSNA.org.
