Repair of saccular aortic aneurysms (SAAs) is frequently recommended based on a perceived predisposition to rupture, despite little evidence that these aneurysms have a more malignant natural history than fusiform aortic aneurysms.
Methods
The radiology database at a single university hospital was searched for the computed tomographic (CT) diagnosis of SAA between 2003 and 2011. Patient characteristics and clinical course, including the need for surgical intervention, were recorded. SAA evolution was assessed by follow-up CT, where available. Multivariate analysis was used to examine potential predictors of aneurysm growth rate.
Results
Three hundred twenty-two saccular aortic aneurysms were identified in 284 patients. There were 153 (53.7%) men and 131 women with a mean age of 73.5 ± 10.0 years. SAAs were located in the ascending aorta in two (0.6%) cases, the aortic arch in 23 (7.1%), the descending thoracic aorta in 219 (68.1%), and the abdominal aorta in 78 (24.2%). One hundred thirteen (39.8%) patients underwent surgical repair of SAA. Sixty-two patients (54.9%) underwent thoracic endovascular aortic repair, 22 underwent endovascular aneurysm repair (19.5%), and 29 (25.6%) required open surgery. The average maximum diameter of SAA was 5.0 ± 1.6 cm. In repaired aneurysms, the mean diameter was 5.4 ± 1.4 cm; in unrepaired aneurysms, it was 4.4 ± 1.1 cm (P < .001). Eleven patients (3.9%) had ruptured SAAs on initial scan. Of the initial 284 patients, 50 patients (with 54 SAA) had CT follow-up after at least 3 months (23.2 ± 19.0 months). Fifteen patients (30.0%) ultimately underwent surgical intervention. Aneurysm growth rate was 2.8 ± 2.9 mm/yr, and was only weakly related to initial aortic diameter (R2 = .19 by linear regression, P = .09 by multivariate regression). Decreased calcium burden (P = .03) and increased patient age (P = .05) predicted increased aneurysm growth by multivariate analysis.
Conclusions
While SAA were not found to have a higher growth rate than their fusiform counterparts, both clinical and radiologic follow-up is necessary, as a significant number ultimately require surgical intervention. Further clinical research is necessary to determine the optimal management of SAA.
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