Abstract
Thoracic aortic aneurysm is a complex disease. The consequences of such silent and indolent disease include acute aortic syndrome if not recognized early and treated appropriately. Aortic aneurysm size was a reliable clinical marker to aid clinical intervention; however, aneurysm growth is variable and is influenced by many factors such as age, presence of connective tissue disorders, genetic disorders, hypertension, inflammatory conditions of the aorta, autoimmune diseases, smoking, and history of previous cardiac surgery. Therefore, aortic size became a non-specific disease surrogate and prediction tool on outcome and intervention. In this review article, we examined the current literature for evidence about aneurysm size and its relation to type A aortic dissection.
Similar content being viewed by others
References
Olsson C, Thelin S, Stahle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14000 cases from 1987 to 2002. Circulation. 2006;114:2611–8.
Meszaros I, Morocz J, Szlavi J, et al. Epidemiology and clinic opathology of aortic dissection. Chest. 2000;117:1271–8.
Goldfinger JZ, Halperin JL, Marin ML, Stewart AS, Eagle KA, Fuster V. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol. 2014;64:1725–39.
Hiratzka LF, Bakris GL, Beckman JA, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/ SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–369.
Erbel R, Aboyans V, Boileau C, et al. ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.
Pape LA, Tsai TT, Isselbacher EM, et al. International Registry of Acute Aortic Dissection (IRAD) Investigators. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2007;116:1120–7.
Parish LM, Gorman JH 3rd, Kahn S, et al. Aortic size in acute type A dissection: implications for preventive ascending aortic replacement. Eur J Cardiothorac Surg. 2009;35:941–5.
Neri E, Barabesi L, Buklas D, et al. Limited role of aortic size in the genesis of acute type A aortic dissection. Eur J Cardiothorac Surg. 2005;28:857–63.
Williams DM, LePage MA, Lee DY. The dissected aorta. Part I. Early anatomic changes in an in vitro model. Radiology. 1997;203:23–31.
Gott VL, Greene PS, Alejo DE, et al. Replacement of the aortic root in patients with Marfan’s syndrome. N Engl J Med. 1999;340:1307–13.
de Beaufort HWL, Trimarchi S, Korach A, et al. Aortic dissection in patients with Marfan syndrome based on the IRAD data. Ann Cardiothorac Surg. 2017;6:633–41.
Erbel R, Eggebrecht H. Aortic dimensions and the risk of dissection. Heart. 2006;92:137–42.
Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489.
Braverman AC. Acute aortic dissection: clinician update. Circulation. 2010;122:184–8.
Januzzi JL, Isselbacher EM, Fattori R, et al. International Registry of Aortic Dissection (IRAD). Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol. 2004;43:665–9.
Estrera AL, Miller CC, Kaneko T, et al. Outcomes of acute type a aortic dissection after previous cardiac surgery. Ann Thorac Surg. 2010;89:1467–74.
Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg. 2006;81:169–77.
Elefteriades JA, Farkas EA. Thoracic Aortic Aneurysm Clinically Pertinent Controversies and Uncertainties. J Am Coll Cadiol. 2010;55:841–57.
Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002;74:S1877–80.
Saliba E, Sia Y. In collaboration with Dore Annie ,El Hamamsy Ismael . The ascending aortic aneurysm: When to intervene? IJC Heart & Vasculature. 2015;6:91–100.
Elefteriades JA, Ziganshin BA, Rizzo JA, et al. Indications and imaging for aortic surgery: size and other matters. J Thorac Cardiovasc Surg. 2015;149:S10–3.
Mokashi SA, Svensson LG. Guidelines for the management of thoracic aortic disease in 2017. Gen Thorac Cardiovasc Surg. 2017. https://doi.org/10.1007/s11748-017-0831-8.
Ziganshin BA, Elefteriades JA. Treatment of Thoracic Aortic Aneurysm: Role of Earlier Intervention. Semin Thorac Cardiovasc Surg. 2015;27:135–43.
Geisbüsch S, Stefanovic A, Schray D, et al. A prospective study of growth and rupture risk of small-to-moderate size ascending aortic aneurysms. J Thorac Cardiovasc Surg. 2014;147:68–74.
Kuzmik GA, Sang AX, Elefteriades JA. Natural history of thoracic aortic aneurysms. J Vasc Surg. 2012;56:565–71.
Elefteriades JA, Pomianowski P. Practical genetics of thoracic aortic aneurysm. Prog Cardiovasc Dis. 2013;56:57–67.
Pomianowski P, Elefteriades JA. The genetics and genomics of thoracic aortic disease. Ann Cardiothorac Surg. 2013;2:271–9.
Chau KH, Elefteriades JA. Natural history of thoracic aortic aneurysms: size matters. plus moving beyond size. Prog Cardiovasc Dis. 2013;56:74–80.
Milewicz DM, Michael K, Fisher N, Coselli JS, Markello T, Biddinger A. Fibrillin-1 (FBN1) mutations in patients with thoracic aortic aneurysms. Circulation. 1996;94:2708–11.
Putnam EA, Zhang H, Ramirez F, Milewicz DM. Fibrillin-2 (FBN2) mutations result in the Marfan-like disorder, congenital contractural arachnodactyly. Nat Genet. 1995;11:456–8.
Hasham SN, Lewin MR, Tran VT, et al. Nonsyndromic genetic predisposition to aortic dissection: a newly recognized, diagnosable, and preventable occurrence in families. Ann Emerg Med. 2004;43:79–82.
Hasham SN, Willing MC, Guo DC, et al. Mapping a locus for familial thoracic aortic aneurysms and dissections (TAAD2) to 3p24-25. Circulation. 2003;107:3184–90.
Ohlmann P, Faure A, Morel O, et al. Diagnostic and prognostic value of circulating D-dimers in patients with acute aortic dissection. Crit Care Med. 2006;34:1358–64.
Parolari A, Trimoli E, Songia P, et al. Biology features of thoracic aortic diseases. Where are we now, where are we heading to: established and emerging biomarkers and molecular pathways. Eur J Cardiothorac Surg. 2013;44:9–23.
Balmforth D, Harky A, Adams B, et al. Is there a role for biomarkers in thoracic aortic aneurysm disease? Gen Thorac Cardiovasc Surg. 2017. https://doi.org/10.1007/s11748-017-0855-0.
Suzuki T, Eagle KA. Biomarker-assisted diagnosis of acute aortic dissection. Circulation. 2018;137:270–2.
Del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med. 2010;42:622–9.
Peng W, Zhu QY, Zhou XH, Chai XP. A simple emergency prediction tool for acute aortic dissection. Iran J Public Health. 2013;42:1085–91.
Rampoldi V, Trimarchi S, Eagle KA, et al. International Registry of Acute Aortic Dissection(IRAD) Investigators. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg. 2007;83:55–61.
Paruchuri V, Salhab KF, Kuzmik G, et al. Aortic size distribution in the general population: Explaining the size paradox in aortic dissection. Cardiology. 2015;131:265–72.
Reeps C, Essler M, Pelisek J, Seidl S, Eckstein HH, Krause BJ. Increased 18Ffluorodeoxyglucose uptake in abdominal aortic aneurysms in positron emission/computed tomography is associated with inflammation, aortic wall instability, and acute symptoms. J Vasc Surg. 2008;48:417–23.
Truijers M, Kurvers HA, Bredie SJ, et al. In vivo imaging ofabdominal aortic aneurysms: increased FDG uptake suggests inflammation in the aneurysm wall. J Endovasc Ther. 2008;15:462–7.
Leung JH, Wright AR, Cheshire N, et al. Fluid structure interaction of patient specific abdominal aortic aneurysms: a comparison with solid stress models. Biomed Eng Online. 2006;5:33.
Poullis MP, Warwick R, Oo A, Poole RJ. Ascending aortic curvature as an independent risk factor for type A dissection, and ascending aortic aneurysm formation: a mathematical model. Eur J Cardiothorac Surg. 2008;33:995–1001.
Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg. 1997;113:476–91.
Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73:17–27.
Çetin M, Kocaman SA, Durakoğlugil ME, et al. Independent determinants of ascending aortic dilatation in hypertensive patients: smoking, endothelial dysfunction, and increased epicardial adipose tissue. Blood Press Monit. 2012;17:223–30.
Roman MJ, Rosen SE, Kramer-Fox R, Devereux RB. Prognostic significance of the pattern of aortic root dilation in the Marfan syndrome. J Am Coll Cardiol. 1993;22:1470–6.
Lazarevic AM, Nakatani S, Okita Y, et al. Determinants of rapid progression of aortic root dilatation and complications in Marfan syndrome. Int J Cardiol. 2006;106:177–82.
Jondeau G, Detaint D, Tubach F, et al. Aortic event rate in the Marfan population: a cohort study. Circulation. 2012;125:226–32.
Della Corte A, Bancone C, Quarto C, et al. Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression. Eur J Cardiothorac Surg. 2007;31:397–404.
Loeys BL, Schwarze U, Holm T, et al. Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med. 2006;355:788–98.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest. Ethical approval, Statement of Human and Animal Rights, Informed consent–Being a Review article, these are not required.
Rights and permissions
About this article
Cite this article
Harky, A., Bashir, M., Antoniou, A. et al. Size and dissection: what is the relation?. Indian J Thorac Cardiovasc Surg 35 (Suppl 2), 72–78 (2019). https://doi.org/10.1007/s12055-018-0687-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12055-018-0687-2