High Prevalence of Thoracic Aortic Dilatation in Men with Previous Inguinal Hernia Repair

Abstract

Background Identifying a useful marker for thoracic aortic dilatation (TAD) could help improve informed clinical decisions, enhance diagnosis, and develop TAD screening programs. Inguinal hernia could be such a marker. This study tested the hypothesis that the thoracic aorta is larger and more often dilated in men with previous inguinal hernia repair versus nonhernia controls.

Methods Four hundred men each with either previous inguinal hernia repair or cholecystectomy (controls) were identified to undergo chest computed tomography to measure the diameter of the thoracic aorta in the aortic root, ascending, isthmic, and descending aorta and to provide self-reported health data. Presence of TAD (root or ascending diameter > 45 mm; isthmic or descending diameter > 35 mm) and thoracic aortic diameters were compared between groups and associations explored using uni- and multivariable statistical methods.

Results Complete data were obtained from 470/718 (65%) eligible participants. TAD prevalence was significantly higher in the inguinal hernia group: 21 (10%) versus 6 (2.4%), p = 0.001 for proximal TAD, 29 (13%) versus 21 (8.3%), p = 0.049 for distal TAD, and 50 (23%) versus 27 (11%), p < 0.001 for all aortic segments combined. In multivariable analysis, previous inguinal hernia repair was independently associated with dilatation of the proximal aorta (odds ratio 5.3, 95% confidence interval 1.8–15, p = 0.003). Contrarily, mean thoracic aortic diameters were similar (root and ascending aorta) or showed clinically irrelevant differences (isthmus and descending aorta).

Conclusion TAD, but not increased aortic diameters on average, was common and significantly more prevalent in men with previous inguinal hernia repair. Hernia could be a marker condition associated with increased prevalence of TAD. Ultimately, TAD screening could consider hernia as a possible selection criterion.

Keywords

thoracic aortic aneurysm - inguinal hernia - risk factors - screening

Publikationsverlauf

Eingereicht: 19. März 2021

Angenommen: 04. Oktober 2021

Artikel online veröffentlicht:
01. November 2022

• References

• 1 Elefteriades JA, Sang A, Kuzmik G, Hornick M. Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm). Open Heart 2015; 2 (01) e000169
• 2 Elefteriades JA, Mukherjee SK, Mojibian H. Discrepancies in measurement of the thoracic aorta: JACC review topic of the week. J Am Coll Cardiol 2020; 76 (02) 201-217
• 1 Howard DPJ, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM. Oxford Vascular Study. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation 2013; 127 (20) 2031-2037
• 2 Pape LA, Awais M, Woznicki EM. et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol 2015; 66 (04) 350-358
• 3 Peterss S, Charilaou P, Dumfarth J. et al. Aortic valve disease with ascending aortic aneurysm: Impact of concomitant root-sparing (supracoronary) aortic replacement in nonsyndromic patients. J Thorac Cardiovasc Surg 2016; 152 (03) 791-798.e1
• 4 Wallen T, Habertheuer A, Bavaria JE. et al. Elective aortic root replacement in North America: analysis of STS adult cardiac surgery database. Ann Thorac Surg 2019; 107 (05) 1307-1312
• 5 Zafar MA, Li Y, Rizzo JA. et al. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg 2018; 155 (05) 1938-1950
• 6 Juvonen T, Ergin MA, Galla JD. et al. Prospective study of the natural history of thoracic aortic aneurysms. Ann Thorac Surg 1997; 63 (06) 1533-1545
• 7 Pape LA, Tsai TT, Isselbacher EM. et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation 2007; 116 (10) 1120-1127
• 8 Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. 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. Circulation 2006; 114 (24) 2611-2618
• 9 Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 1996; 25 (04) 835-839
• 10 Hager A, Kaemmerer H, Rapp-Bernhardt U. et al. Diameters of the thoracic aorta throughout life as measured with helical computed tomography. J Thorac Cardiovasc Surg 2002; 123 (06) 1060-1066
• 11 Kälsch H, Lehmann N, Möhlenkamp S. et al. Body-surface adjusted aortic reference diameters for improved identification of patients with thoracic aortic aneurysms: results from the population-based Heinz Nixdorf Recall study. Int J Cardiol 2013; 163 (01) 72-78
• 12 Rogers IS, Massaro JM, Truong QA. et al. Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol 2013; 111 (10) 1510-1516
• 13 Pham MHC, Ballegaard C, de Knegt MC. et al. Normal values of aortic dimensions assessed by multidetector computed tomography in the Copenhagen General Population Study. Eur Heart J Cardiovasc Imaging 2019; 20 (08) 939-948
• 14 Ziganshin BA, Zafar MA, Elefteriades JA. Descending threshold for ascending aortic aneurysmectomy: is it time for a “left-shift” in guidelines?. J Thorac Cardiovasc Surg 2019; 157 (01) 37-42
• 15 Larsson E, Vishnevskaya L, Kalin B, Granath F, Swedenborg J, Hultgren R. High frequency of thoracic aneurysms in patients with abdominal aortic aneurysms. Ann Surg 2011; 253 (01) 180-184
• 16 Lehnert B, Wadouh F. High coincidence of inguinal hernias and abdominal aortic aneurysms. Ann Vasc Surg 1992; 6 (02) 134-137
• 17 Pleumeekers HJ, De Gruijl A, Hofman A, Van Beek AJ, Hoes AW. Prevalence of aortic aneurysm in men with a history of inguinal hernia repair. Br J Surg 1999; 86 (09) 1155-1158
• 18 Henriksen NA, Sorensen LT, Jorgensen LN, Lindholt JS. Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort. Br J Surg 2013; 100 (11) 1478-1482
• 19 Olsson C, Eriksson P, Franco-Cereceda A. Association between thoracic aortic disease and inguinal hernia. J Am Heart Assoc 2014; 3 (04) e001040
• 20 Hung KC, Chang YJ, Sun CK. et al. Association of hernia with subsequent aortic aneurysm in geriatric patients. J Thorac Cardiovasc Surg 2020; •••: S0022-5223 (20)30513-4
• 21 Rosch R, Klinge U, Si Z, Junge K, Klosterhalfen B, Schumpelick V. A role for the collagen I/III and MMP-1/-13 genes in primary inguinal hernia?. BMC Med Genet 2002; 3: 2
• 22 Hiratzka LF, Bakris GL, Beckman JA. et al; 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55 (14) e27-e129
• 23 Landenhed M, Engström G, Gottsäter A. et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc 2015; 4 (01) e001513
• 24 Ziganshin BA, Theodoropoulos P, Salloum MN. et al. Simple renal cysts as markers of thoracic aortic disease. J Am Heart Assoc 2016; 5 (01) e002248
• 25 Jackson V, Olsson C, Eriksson P, Franco-Cereceda A. Aortic dimensions in patients with bicuspid and tricuspid aortic valves. J Thorac Cardiovasc Surg 2013; 146 (03) 605-610