Ruptured Aortic Aneurysm and Dissection Related Death: an Autopsy Database Analysis
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ORIGINAL ARTICLE
Ruptured Aortic Aneurysm and Dissection Related Death: an Autopsy Database Analysis Dániel Pál 1 & Brigitta Szilágyi 2 & Márton Berczeli 1 & Csaba Imre Szalay 3 & Balázs Sárdy 1 & Zoltán Oláh 1 & Tamás Székely 4 & Gergely Rácz 5 & Péter Banga 1 & Zsófia Czinege 1 & Péter Sótonyi 1 Received: 22 March 2020 / Revised: 22 March 2020 / Accepted: 27 May 2020 # The Author(s) 2020
Abstract Acute aortic catastrophes (AAC), mainly ruptured aneurysms and dissections, lead all other vascular conditions in morbidity and mortality, even if intervention occurs. The aim of our study was to give a descriptive overview of the demographic and pathological characteristics of AAC. Between 1994 and 2013, 80,469 autopsies were performed at Semmelweis University hospitals in Budapest. After collecting the autopsy reports we were able to create the AAC database upon which we conducted our analysis. We found 567 cases of AAC. The cause of death in 120 of them was classified as a non-ruptured aorta with malperfusion or distal embolization. Of the remaining 447 cases, in 305 the cause of death was a ruptured aortic aneurysm (rAA), and in 142 it was a ruptured aortic dissection (rAD). The distribution of rAA cases was 34.4% thoracal, 4.3% thoracoabdominal, and 61.3% abdominal. We found female dominance where the rAA was thoracal. In rAD cases, 84% were Stanford A and 16% Stanford B type. In both groups we found different pathological distributions. In the prehospital group, the number of thoracal ruptures was considerable. 88% of the patients with Stanford A dissection died in the prehospital or perioperative period. The most progressive AACs were ruptures of intrapericardial aneurysms and Stanford A dissections., however survival rate can be elevated by using rapid imaging examination and immediate surgical intervention. We want to highlight that our study contains such gender differences, which are worth to be taken into consideration. Keywords Acute aortic syndrome . Aortic dissection . Aortic aneurysm . Autopsy . Rupture . Bleeding
Abbreviations AAC Acute aortic catastrophes AAA Abdominal aortic aneurysm rAA Ruptured aortic aneurysm rAD Ruptured aortic dissection
* Péter Sótonyi [email protected]; [email protected] 1
Heart and Vascular Center, Department of Vascular and Endovascular Surgery, Semmelweis University, Városmajor u. 68, Budapest 1122, Hungary
2
Department of Geometry, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
3
Heart and Vascular Center, Department of Cardiology, Semmelweis University, Budapest, Hungary
4
2nd Department of Pathology, Semmelweis University, Budapest, Hungary
5
1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
TAA ThAA rAAC nrAAC
Thoracal aortic aneurysm Thoracoabdominal aortic aneurysm Ruptured acute aortic catastrophe Non-ruptured acute aortic catastrophe
Introduction Cardiovascular diseases are the leading cause of death in Hungary [1]. Among them, AACs
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