Pelvic artery aneurysm screening provides value in patients with thoracic aortic aneurysms.

Approximately » of patients with thoracic aortic aneurysms (TAAs) have concomitant abdominal aortic aneurysms (AAAs), thereby justifying the addition of an abdominal CT scan to a chest CT scan in patients with a newly diagnosed or suspected TAA. However, the prevalence of pelvic artery aneurysms (PAAs) in these patients is unknown. The purpose of this study was to determine the prevalence of PAAs in patients with TAAs and to assess what patient specific factors were associated with PAAs, thereby providing insight into the usefulness of pelvic imaging in TAA patients. Consecutive non-operated patients seen in Cardiac Surgery clinic between 2008 and 2013 with a TAA and a CT scan of the chest/abdomen/pelvis were included. Scans of 371 patients were evaluated for PAAs using threshold diameters of 20 and 15 mm for common iliac artery aneurysms (CIAs) and internal iliac artery aneurysms (IIAs), respectively, on 3D analysis. The prevalence of PAAs was determined and multiple logistic regression was used to identify associated risk factors. 41 of 371 (11.1%) patients with a TAA had at least one PAA. Factors showing positive associations with PAAs included increased age (p = 0.0004), male gender (p = 0.0007), descending TAA location (p = 0.0024) and presence of an AAA (p < 0.0001). The results of our study suggest that the addition of pelvic imaging for PAA screening in patients undergoing an initial CT scan of the chest and abdomen for a TAA is valuable, particularly in patients with the following demographics: age ≥65, male gender, descending TAA location, and/or known AAA.

Evaluation for abdominal aortic aneurysms is justified in patients with thoracic aortic aneurysms.

Aortic aneurysms are a significant cause of mortality, and the presence of multiple aneurysms may affect treatment plans. The purpose of this study was to determine the frequency of abdominal aortic aneurysms (AAAs) in patients with thoracic aortic aneurysms (TAAs) and to establish whether patient specific factors, such as gender and comorbidities, influenced the frequency of AAAs, thereby indicating if and when abdominal aortic evaluation is justified. Electronic medical records were reviewed from 1000 patients with a computed tomography (CT) angiogram of the chest and abdomen and a clinical diagnosis of TAA from Cardiac Surgery clinic between 2008 and 2013. 538 patients with history of aortic intervention, dissection, rupture or trauma were excluded. The frequency of AAAs among the 462 remaining patients was established, and statistical analysis was used to elucidate differences in frequency based on age, gender, comorbidities, and TAA location. Overall, 104 of 462 (22.5 %) patients with a TAA also had an AAA. There were significant differences in the frequency of AAA based on TAA location, age, and comorbidities. The following comorbidities showed positive associations with AAA using logistic regression analysis: age ≥65 (P < 0.0001; OR 30.1; CI 7.14-126.61), smoking history (P < 0.0001; OR 4.1; 2.35-7.30), and hypertension (P = 0.024; OR 2.1; CI 1.11-4.16). Aneurysms in the proximal/mid descending (P < 0.0001; OR 4.96; CI 2.32-10.61) and diaphragm level (P < 0.0001; OR 38.4; CI 14.71-100.15) of the aorta also showed a positive association with AAAs when adjusted for age and gender. AAA screening in patients with TAA is a reasonable, evidence-based option regardless of the TAA location, with the strongest support in patients >age 55, with systemic hypertension, a smoking history and/or a TAA in the descending thoracic aorta.