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Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada: a population-based study

McClure SR, Brogly SB, Lajkosz K, Payne D, Hall SF, Johnson AP. J Thorac Cardiovasc Surg. 2018; 155(6):2254-64.e4. Epub 2018 Feb 2.


Objectives — To determine hospital incidence, mortality and management for thoracic aortic dissections and aneurysms.

Methods — A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada was carried out. Incident cases of thoracic aortic dissections and aneurysms were identified between 2002 - 2014. Treatment and mortality trends were assessed.

Results — There were 5966 aortic dissections (Type A, n = 2289, 38%; Type B, n = 3632, 61%). Overall incidence proportion for aortic dissections was 4.6/100000. There were 9392 thoracic aortic aneurysms with an overall incidence proportion of 7.6/100000. The incidence for both dissections and aneurysms significantly increased over the 12-year study. Only 53% (1204/2289) of Type A dissections underwent surgery. Type B dissection treatment was 83% (3000/3632) medical, 10% (370/3632) surgery and 7% (262/3632) endovascular. Thoracic aortic aneurysm treatment was 53% (4940/9392) surgery, 44% (4129/9392) medical and 3% (323/9392) endovascular. 35% (323/924) of known descending thoracic aortic aneurysms received a stent graft. Cardiac surgeons performed 87% of the open surgical repairs. Vascular surgeons performed 91% of the endovascular procedures. All cause 3-year mortality significantly decreased for both aortic dissections (44% to 40%) and aneurysms (30% to 22%). All cause hospital mortality also decreased. Women had worse outcomes than men.

Conclusions — The incidence of thoracic aortic dissections and aneurysms increased over time but all cause hospital and late outcomes improved. Gender differences exist. Men incur more disease but women having higher hospital mortality. Surgery was primarily referred to cardiac surgeons. Endovascular therapy was primarily referred to vascular surgeons.

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