Aortic dissection: increased risk of rupture compared with other types of aneurysm.

Clinical bottom line (level 2b)

  1. Patients who were not operated on with dissecting aneurysms were more likely to have a rupture than patients with other types of aneurysm, though no more likely to die.
  2. The type of dissection had no effect on the chance of rupture.
Perko et al: Annals of Thoracic Surgery 1995; 59: 1204-1209
Expires December 2004

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Denmark

170 patients (aged range 32 to 93 years; mean 69, 65% male) aortic aneurysms who were not operated on (28% for technical reasons, 21% due to associated disease, 13% due to poor anaesthetic risk) from 1984-93.

Factors studied:
  • rupture, death
  • dissection aneurysm
  • dissection aneurysm




    • Multivariate regression analysis was performed on confounding factors.

    ? followed for about 7 years
    Outcomes studied:
  • died during follow-up
  • rupture

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    died during follow-up about 7 years 132/170 78%
    (71% to 84%)
    rupture about 7 years 78/170 46%
    (38% to 53%)

    prognostic factor for
    died during follow-up     		time to outcome control rate (%) unadjusted OR
    (95% CI)
    dissection aneurysm ? 0.91
    (0.39 to 2.1)

    prognostic factor for
    rupture     		time to outcome control rate (%) unadjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    dissection aneurysm ? 3.3
    (1.6 to 7.2)     		4
    (2 to 13)

    • Multivariate analysis showed the following to be independently associated with death:
      • diameter of aneurysm
      • renal failure
      • hypertension
    • Rupture associated with:
      • diameter of aneurysm
      • renal failure

    Comments

    1. No odds ratios were given for any of the factors.

    Citation

    1. Perko MJ, Norgaard M, Herzog TM, et al: Unoperated aortic aneurysm: A survey of 170 patients. Annals of Thoracic Surgery 1995; 59: 1204-1209
    Contributor: Chris Ball and Clare Wotton, December 2000
    Reviewer:

    Clinical Question.
    Patient aortic aneurysms
    Intervention or Exposure prevalence
    Outcome rupture