Cardiovascular medicine
Clinical and patho-anatomical factors affecting expansion of
thoracic aortic aneurysms
R S Bonsera, D Paganoa, M E Lewisa, S J Rooneya, P Guestb, P Daviesc, I Shimadaa
a Department of
Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital
NHS Trust, Edgbaston, Birmingham B15 2TH, UK, b Department of Radiology, Queen Elizabeth
Hospital, c Department of
Mathematics and Statistics, University of Birmingham
Correspondence to: Mr Bonser email: r.s.bonser{at}bham.ac.uk
Accepted 11 April 2000
OBJECTIVE
To examine the expansion of
aneurysmal aortic segments (
35 mm) and to assess the impact of
clinical and patho-anatomical factors on aneurysm expansion.
DESIGN87 consecutive patients (mean
age 63.6 years, range 22-84 years) were studied using serial (six
month intervals) computed tomographic or magnetic resonance imaging to
monitor progression of thoracic aortic aneurysms. Aortic diameter was
measured at seven predetermined segments and at the site of maximum
aortic dilatation (MAX).
RESULTS780 segment intervals were
identified. The median overall aneurysm expansion rate was
1.43 mm/year. This increased exponentially with incremental aortic
diameter (p < 0.01) and varied by anatomical segment (p < 0.05).
The presence of intraluminal thrombus (p < 0.01) but not dissection
or calcification was associated with accelerated growth. Univariate
analysis identified thrombus (p < 0.001), previous stroke
(p < 0.002), smoking (p < 0.01), and peripheral vascular disease
(p < 0.05) as factors associated with accelerated growth in
MAX. Dissection, wall calcification, and history of
hypertension did not affect expansion. 
Blocker treatment was not
associated with protection. Multivariate analysis confirmed the
positive effect of intraluminal thrombus and previous cerebral ischaemia, and the negative effect of previous aortic surgery on
aneurysm growth. These findings translated into a mathematical equation
describing exponential aneurysm expansion.
CONCLUSIONSAneurysmal thoracic
aortic segments expand exponentially according to their initial size
and their anatomical position within the aorta. The presence of
intraluminal thrombus, atherosclerosis, and smoking history is
associated with accelerated growth and may identify a high risk patient
group for close surveillance.
Keywords: thoracic aortic aneurysm; expansion rate
© 2000 by Heart
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