Análisis de la degeneración aneurismática en pacientes con diagnóstico previo de disección aórtica

Lara-Hernández, R.; Lozano-Vilardell, P.; Cordobés-Gual, J.; Torreguitart-Mirada, N.; Riera-Vázquez, R.; Manuel-Rimbau, E.

doi:10.1016/S0003-3170(06)74970-7

Información del artículo

Resumen

Bibliografía

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Estadísticas

Resumen

Introducción

Diversos estudios han relacionado la degeneración aórtica aneurismática con la disección previa, sobre todo en pacientes con hipertensión arterial.

Objetivo

Analizar la tasa de degeneración aneurismática en los pacientes con diagnóstico previo de disección aórtica.

Pacientes y métodos

Estudio observacional retrospectivo de 70pacientes que sobrevivieron al episodio agudo de disección aórtica toracoabdominal, entre 1994y 2003. La media de edad fue de 65,3 años. Control anual con tomografia axial computarizada. Se analizan los factores de riesgo cardiovascular, comorbilidades asociadas y estado de la falsa luz.

Resultados

El seguimiento medio fue de 30 meses. Se observó degeneración en 44 pacientes (62,8%). El tiempo medio de degeneración aneurismática fue de 31,6 meses. La degeneración aneurismática fue más frecuente en la disección tipo B (67,5% frente al 57,5% tipo A). Se realizó cirugía urgente por rotura aneurismática en seis pacientes, cirugía electiva en 18 pacientes, y 20 recibieron tratamiento conservador. La hipertensión arterial -riesgo relativo (RR): 1,01; intervalo de confianza (IC) 95%: 1,1-2,4- y la permeabilidad de la falsa luz (RR: 1,88; IC 95%: 1,1-5,3) se relacionaron con la degeneración aneurismática. Se relacionaron con la degeneración en la fase aguda de la disección la edad superior a 70 años (p = 0,025) y la permeabilidad de la falsa luz (p = 0,013). Una falsa luz permeable (RR: 9,6; IC 95%: 1,2-91,1) y el diámetro aórtico mayor de 5cm (RR: 1,3; IC 95%: 1,1-1,6) son factores predictivos de rotura.

Conclusiones

Existe una alta tasa de degeneración aneurismática en la disección con afectación aórtica toracoabdominal, respecto a la que la hipertensión arterial y la permeabilidad de la falsa luz son los principales factores relacionados.

Palabras clave:

Aneurisma abdominal

Aneurisma toracoabdominal

Degeneración aneurismática

Disección aórtica

Hipertensión arterial

Permeabilidad de la falsa luz

Rotura aneurismática

Summary

Introduction

A number of studies have related aneurysmal aortic degeneration to prior dissection, above all in patients with arterial hypertension.

Aim

To analyse the rate of aneurysmal degeneration in patients previously diagnosed with aortic dissection.

Patients and methods

We conducted a retrospective observational study involving 70 patients who survived an acute episode of thoracoabdominal aortic dissection between 1994 and 2003. Mean age was 65.3 years. Patients were submitted to annual controls using computerised axial tomography scans. Cardiovascular risk factors, associated comorbidities and the false lumen status were all analysed.

Results

Mean follow-up time was 30 months. Degeneration was observed in 44patients (62.8%). The mean time of aneurysmal degeneration was 31.6 months and was more frequent in type B dissections (67.5 versus 57.5% in type A). Urgent surgical treatment was performed to treat aneurysmal rupture in 6 patients, 18 patients were submitted to elective surgery and 20 patients received conservative treatment. Arterial hypertension –relative risk (RR): 1.01; 95% confidence interval (CI): 1.1-2.4– and false lumen patency (RR: 1.88; CI 95%: 1.1-5.3) were related to aneurysmal degeneration. An age above 70 years (p =0.025) and false lumen patency (p =0.013) were linked to degeneration in the acute phase of the dissection. A false lumen patency (RR: 9.6; CI 95%: 1.2-91.1) and an aortic diameter above 5cm (RR: 1.3; CI 95%: 1.1-1.6) are factors predicting rupture.

Conclusions

The rate of aneurysmal degeneration in dissection involving the thoracoabdominal aorta is high: arterial hypertension and false lumen patency are the main related factors.

Key words:

Abdominal aneurysm

Aneurysmal degeneration

Aneurysmal rupture

Aortic dissection

Arterial hypertension

False lumen patency

Thoracoabdominal aneurysm

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