Natural History of the Ectatic Aorta

Abstract

Objectives
To define the natural history of ectatic abdominal aortas and to assess the clinical need for follow-up.

Design
Abdominal aortas were considered ectatic if they were diffusely and irregularly dilated with a diameter less than 3 cm. Ectatic aortas were identified either by AAA screening or as incidental findings. Patients who had only one scan were excluded from the study. Clinical data were analysed.

Setting
Two district general hospitals in Wales and England.

Subjects
116 patients (90 men).

Results
The median age of patients was 71 years (range 48–90). Co-existing risk factors included hypertension (75), IHD (22), PVD (8), diabetes (3), COAD (14), stroke (5), popliteal aneurysm (1), malignant disease (3) and 4 had a family history of AAA. The median follow-up was 24 months (range 5–72). The median and maximum growth rate of the ectatic aortas were 0.65 and 14.4 mm/year respectively. In three patients the expansion rate was more than 5 mm/year. In 22 patients the ectatic aorta became aneurysmal, reaching a diameter greater than 3 cm. There were no ruptures and no elective repairs. Two deaths occurred due to IHD.

Conclusions
This study demonstrates that if ectatic aortas do expand they do so very slowly. However, 22 of the 116 (19%) became aneurysmal in a follow-up of twp years. Once identified ectatic aortas should be scanned at intervals of three years.

Full text

!I
ELSEVIER
WWw.elsevier.com/locate!cardiosur
.
..
Cardiovascular Surgery, Vol.
II,
No.4,
pp. 273-276, 2003
©2003 Published by Elsevier SCience Ltd on behalf of The International Society for Cardiovascular Surgery
0967-2109/03 $30.00
dol:IO.IOI6lS0967·2109(02)OOI76-9
Natural history of the ectatic aorta
P.
S.
Basnyat*,
S.
Alone'.
A.
A.
Warsi*,
T.
R.
Magee
t,
R.
B.
Galland'
and
M. H.
Lewis*
•
Royal
Glamorgan
HospifAP.
Ynysmaerdy,
Llantrisant,
CF72
8XR,
Wales,
UK
and
tRoyal
Berkshire
Hospital.
Reading,
England.
UK
Objectives: To define
the
natural history
of
ectatic abdominal aortas and
to
assess
the
clinical
need
for
follow-up.
Design: Abdominal aortas were considered ectatic
if
they
were diffusely and irregularly
dilated
with
a
diameter
less than 3 cm. Ectatic aortas were identified either by AAA screening
or as incidental findings. Patients who had only one scan were excluded
from
the
study. Clinical
data were analysed.
Setting: Two
district
general hospitals in Wales and England.
SuQjects:
116 patients (90 men).
Results: The median age of patients was 71 years (range 48-90). Co-existing risk factors
included hypertension (75), IHD (22),
PVD
(8), diabetes (3),
COAD
(14). stroke (5), popliteal
aneurysm (1), malignant disease (3) and 4 had a family history
of
AAA. The median follow-
up was 24
months
(range 5-72). The median and
maximum
growth
rate
of
the
ectatic aortas
were 0.65 and 14.4
mmlyear
respectively. In
three
patients
the
expansion rate was
more
than
5mmlyear. In 22 patients
the
ectatic aorta became aneurysmal, reaching a
diameter
greater
than
3cm. There were no
ruptures
and no elective repairs. Two deaths occurred due
to
IHD.
Conclusions:
This study demonstrates
that
if
ectatic aortas do expand
they
do so very slowly.
However. 22
of
the
116 (19%) became aneurysmal in a follow-up
of
twp
years. Once identified
ectatic aortas should be scanned
at
intervals
of
three
years.
©2003 Published by Elsevier Science Ltd on behalf
of
The International Society
for
Cardio-
vascular Surgery
Keywords:
abdominal
aorta.
aneurysm.
ectatic
aorta,
surveillance
IntrOduction
Jhe
incidence of
a~dominal
aortic
a?eurys~
(~)
epends on the criteria used for diagnosis. Colhn
proposed that an aortic aneurysm was present when
the maximum external diameter of the infrarenal
abdominal aorta was either greater than 4ern or
iorrespondence
to:
M.H.
Lewis. Tel.: +44-1443-443443 Ext. 3540;
ax: +44-1443-443224
~oYal
Glamorgan Hospital previously known as East Glamorgan
eneral Hospital
CARDIOVASCULAR
SURGERY
AUGUST
2003
VOL
11
NO
4
exceeded the maximum diameter of the aorta
between the origin of the superior mesenteric and
left renal arteries by at least
0.5
em
[lJ.
Johnston et
al suggested an AAA as a permanent localised dila-
tation of at least
50%
increase in diameter compared
with the expected normal diameter of the abdominal
aorta [2J. However normal values for the abdominal
aorta depend on method of measurement and
patient's age, sex, race, height, weight, body mass
index, body surface area and blood pressure [2,3J.
Because the average normal infrarenal aortic diam-
eter is 2.0 ern, the standard definition of AAA is now
considered to be an abdominal aorta with maximum
infrarenal aortic external diameter
of
3 em or more
273