Published Online
on December 4, 2006

A more recent version of this article appeared on December 12, 2006

This Article Full Text (PDF) CME: Take the course for this article: Circulation: December 12, 2006, Volume 114, Number 24 All Versions of this Article: 114/24/2611    most recent CIRCULATIONAHA.106.630400v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Olsson, C. Articles by Granath, F. Search for Related Content PubMed PubMed Citation Articles by Olsson, C. Articles by Granath, F. Related Collections CV surgery: aortic and vascular disease Epidemiology Related Article

Submitted on April 3, 2006
Revised on October 18, 2006
Accepted on October 20, 2006

Thoracic Aortic Aneurysm and Dissection. Increasing Prevalence and Improved Outcomes Reported in a Nationwide Population-Based Study of More Than 14 000 Cases From 1987 to 2002

Christian Olsson MD^*, Stefan Thelin MD, PhD, Elisabeth Ståhle MD, PhD, Anders Ekbom MD, PhD, and Fredrik Granath PhD

From the Department of Cardiothoracic Surgery (C.O., S.T., E.S.), Uppsala University Hospital, Uppsala, and the Department of Internal Medicine (A.E., F.G.), Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.

^* To whom correspondence should be addressed. E-mail: christian.olsson{at}surgsci.uu.se.

Background--Current knowledge of prevalence, incidence, and survival in thoracic aortic diseases (aneurysm and dissection) is based on small studies from a dated era of treatment and diagnostic procedures. The objective of the present study was to reappraise epidemiology and long-term outcomes in subjects with thoracic aortic disease in a large contemporary population.

Methods and Results--All subjects with thoracic aortic aneurysm or dissection identified in Swedish national healthcare registers from 1987 to 2002 were included in the present study. Of 14 229 individuals with thoracic aortic disease, 11 039 (78%) were diagnosed before death. Incidence of thoracic aortic disease rose by 52% in men and by 28% in women to reach 16.3 per 100 000 per year and 9.1 per 100 000 per year, respectively. Operations increased 7-fold in men and 15-fold in women over time. Of the 2455 patients who underwent operation, 389 (16%) died within 30 days, with older age and thoracic aortic rupture as risk factors. In Cox analysis, increasing age was the only variable associated with long-term mortality. Both short- and long-term mortality improved over time. In patients who underwent operation, actuarial survival (95% CI) at 1, 5, and 10 years was 92% (91% to 93%), 77% (75% to 80%), and 57% (53% to 61%), respectively. The cumulative incidence of thoracic aortic reoperations was 7.8% at 10 years.

Conclusions--The prevalence and incidence of thoracic aortic disease was higher than previously reported and increasing. The annual number of operations increased substantially. Surgical (30-day) and long-term survival improved significantly over time to form a growing cohort of patients needing counseling, management decisions, operations, and extended postoperative surveillance.

Key words: aneurysm • aorta • dissection • epidemiology • surgery • survival

Related Article:

Issue Highlights
Circulation 2006 114: 2571. [Extract] [Full Text]

This article has been cited by other articles:

				H. Miyata, N. Motomura, Y. Ueda, H. Tsukihara, K. Tabayashi, and S. Takamoto Toward quality improvement of thoracic aortic surgery: estimating volume-outcome effect from nationwide survey Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 517 - 521. [Abstract] [Full Text] [PDF]

				L. M. Parish, J. H. Gorman III, S. Kahn, T. Plappert, M. G. St. John-Sutton, J. E. Bavaria, and R. C. Gorman Aortic size in acute type A dissection: implications for preventive ascending aortic replacement Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 941 - 946. [Abstract] [Full Text] [PDF]

				T. M. Tadros, M. D. Klein, and O. M. Shapira Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve: Pathophysiology, Molecular Biology, and Clinical Implications Circulation, February 17, 2009; 119(6): 880 - 890. [Full Text] [PDF]

				C. A. Nienaber, I. Akin, R. Erbel, and A. Haverich CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				R. Ramaraj Sudden onset of headache and recent breathlessness BMJ, November 12, 2008; 337(nov12_2): a1844 - a1844. [Full Text]

				J. D. Parker and J. Golledge Outcome of Endovascular Treatment of Acute Type B Aortic Dissection Ann. Thorac. Surg., November 1, 2008; 86(5): 1707 - 1712. [Abstract] [Full Text] [PDF]

				R Meenakshisundaram and P Thirumalaikolundusubramanian Resident's knowledge on thoracic aortic dissection Postgrad. Med. J., May 1, 2008; 84(991): 278 - 278. [Full Text] [PDF]

				L. G. Svensson, N. T. Kouchoukos, D. C. Miller, J. E. Bavaria, J. S. Coselli, M. A. Curi, H. Eggebrecht, J. A. Elefteriades, R. Erbel, T. G. Gleason, et al. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts Ann. Thorac. Surg., January 1, 2008; 85(1_Supplement): S1 - S41. [Abstract] [Full Text] [PDF]

				W. Y. Szeto, J. E. Bavaria, F. W. Bowen, A. Geirsson, K. Cornelius, W. C. Hargrove, and A. Pochettino Reoperative Aortic Root Replacement in Patients With Previous Aortic Surgery Ann. Thorac. Surg., November 1, 2007; 84(5): 1592 - 1599. [Abstract] [Full Text] [PDF]

				L. A. Matura, V. B. Ho, D. R. Rosing, and C. A. Bondy Aortic Dilatation and Dissection in Turner Syndrome Circulation, October 9, 2007; 116(15): 1663 - 1670. [Abstract] [Full Text] [PDF]