P076. Causes of Death from Descending Aortic Disease - An Autopsy-based Study
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Mayo Clinic (Rochester, MN)
Rochester, MN
United States - Contact Me
2023-current time Research Fellow at cardiovascular surgery department at the Mayo Clinic (Rochester, MN, USA)
2021-2023 Fellow of the heart valve surgery department of the E. Meshalkin State Research Institute Blood Circulation Pathology (Novosibirsk, Russian Federation)
2019-2021 Cardio-vascular surgery residency E. Meshalkin State Research Institute Blood Circulation Pathology (Novosibirsk, Russian Federation)
2013-2019 Odessa National Medical University (Odessa, Ukraine)
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Pathology of the descending aorta is commonly perceived to be less dangerous compared to ascending and root disease, sometimes resulting in less aggressive surgical management. However, in some cases, complications are fatal. In this study, we aimed to describe characteristics of descending aortic conditions leading to aortic rupture and death.
Methods: We reviewed autopsy reports of a consecutive series of 30 patients who died due to rupture of the descending aorta before receiving surgical treatment. Post-mortem examinations were performed at our institution from 1994 to 2022, and autopsy data were supplemented with available clinical information.
Results: Pathologic examination revealed that the underlying causes of aortic rupture were atherosclerotic aneurysms in 18 patients (60%), aortic dissection in 10 patients (33.3%), penetrating ulcer in 1 patient (3.3%), and 1 case (3.3%) of intramural hematoma. The most common initial symptom for atherosclerotic aneurysm patients was collapse (n=6, 33.3%), whereas back pain (n=5, 50%) was prominent in the dissection group. The median interval between the onset of symptoms and death was 6 (1-96) hours for atherosclerotic aneurysm patients and 3 (1-48) hours for those with dissection (p=NS). Among all patients, 9 (30%) were found dead at home with an unknown time of death, 7 patients (23.3%) received unsuccessful resuscitation out of the hospital, 5 (16.7%) expired enroute to the hospital, and 9 (30%) died in the emergency room. From available clinical information, 20 patients (66.7%) had a history of hypertension. In patients with type B aortic dissection, 5 (50%) had acute dissection, 3 had chronic dissection with aneurysm formation, and 2 (20%) had chronic dissection without aneurysmal enlargement (surgery was not indicated). Among the 18 patients with rupture of an atherosclerotic aneurysm, the median aortic diameter was 6.0 cm (5.4-7.8 cm). The atherosclerotic aneurysm was limited to the descending aorta in 55.6% of patients, and (44.4%) had thoracoabdominal aneurysms. The distribution of thoracoabdominal aortic aneurysms was Crawford Type I - 1 patient, Type II - 3 patients, and Type III and Type IV - 2 patients each. Among the 20 patients who died because of aneurysm rupture, 7 had not been diagnosed with aneurysm antemortem; 2 of them declined surgery due to the high risk of the procedure. Eleven patients had aneurysms >5.5cm identified on imaging but did not have surgical referral in a timely fashion.
Conclusions: In this study, an atherosclerotic aneurysm was the most frequent descending aortic pathology that led to death. While not all cases of descending aortic aneurysms require emergent intervention, it is extremely important to schedule surgical intervention soon after guidelines thresholds are met especially in view of the availability of endovascular therapy for the majority of patients with descending aortic pathology.
Authors
Anastasiia Karadzha (1), Hartzell Schaff, MD (1), Robert Frye (1), Melanie Bois (1), Malakh Shrestha (1)
Institutions
(1) Mayo Clinic, Rochester, MN
Methods: We reviewed autopsy reports of a consecutive series of 30 patients who died due to rupture of the descending aorta before receiving surgical treatment. Post-mortem examinations were performed at our institution from 1994 to 2022, and autopsy data were supplemented with available clinical information.
Results: Pathologic examination revealed that the underlying causes of aortic rupture were atherosclerotic aneurysms in 18 patients (60%), aortic dissection in 10 patients (33.3%), penetrating ulcer in 1 patient (3.3%), and 1 case (3.3%) of intramural hematoma. The most common initial symptom for atherosclerotic aneurysm patients was collapse (n=6, 33.3%), whereas back pain (n=5, 50%) was prominent in the dissection group. The median interval between the onset of symptoms and death was 6 (1-96) hours for atherosclerotic aneurysm patients and 3 (1-48) hours for those with dissection (p=NS). Among all patients, 9 (30%) were found dead at home with an unknown time of death, 7 patients (23.3%) received unsuccessful resuscitation out of the hospital, 5 (16.7%) expired enroute to the hospital, and 9 (30%) died in the emergency room. From available clinical information, 20 patients (66.7%) had a history of hypertension. In patients with type B aortic dissection, 5 (50%) had acute dissection, 3 had chronic dissection with aneurysm formation, and 2 (20%) had chronic dissection without aneurysmal enlargement (surgery was not indicated). Among the 18 patients with rupture of an atherosclerotic aneurysm, the median aortic diameter was 6.0 cm (5.4-7.8 cm). The atherosclerotic aneurysm was limited to the descending aorta in 55.6% of patients, and (44.4%) had thoracoabdominal aneurysms. The distribution of thoracoabdominal aortic aneurysms was Crawford Type I - 1 patient, Type II - 3 patients, and Type III and Type IV - 2 patients each. Among the 20 patients who died because of aneurysm rupture, 7 had not been diagnosed with aneurysm antemortem; 2 of them declined surgery due to the high risk of the procedure. Eleven patients had aneurysms >5.5cm identified on imaging but did not have surgical referral in a timely fashion.
Conclusions: In this study, an atherosclerotic aneurysm was the most frequent descending aortic pathology that led to death. While not all cases of descending aortic aneurysms require emergent intervention, it is extremely important to schedule surgical intervention soon after guidelines thresholds are met especially in view of the availability of endovascular therapy for the majority of patients with descending aortic pathology.
Authors
Anastasiia Karadzha (1), Hartzell Schaff, MD (1), Robert Frye (1), Melanie Bois (1), Malakh Shrestha (1)
Institutions
(1) Mayo Clinic, Rochester, MN
Presentation Duration
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