Immunosuppressive Agents and Aortic Aneurysm: Real Correlation or Mere Coincidence?

Background: Aortic aneurysm is a potentially lethal disease requiring treatment. Atherosclerosis, hypertension, age, but also rare diseases such as Marfan’s syndrome represent a risk factor. We have discovered that a significant proportion of our patients were previously on chemotherapy treatment or long-term treatment with cytostatics or immunosuppressive drugs. Thus, we examined a possible correlation more exactly.

Methods: In this study, 224 patients with aortic aneurysm were retrospectively analyzed after aortic surgery from 2006 to 2016. Seventy-three patients received an aortic wrapping, 89 patients underwent an aortic replacement, hereof 89 had a valve-carrying conduit, and 62 a supracoronary ascendens replacement. Twenty-five patients suffered from type A dissection. Aortic morphology was assessed by means of computed tomography scan before and after surgeries. Demographic data, risk profile, and postoperative complications were collected. Short-term and long-term survival analyses were performed. Statistical analysis was performed with SPSS 19.0.

Results: Gender was predominately male 69.2% (p < 0.001). Mean log EuroSCORE was 15.58%. While the incidence of aortic aneurysms in Germany is ca. 15 in 100,000, about 1 in 100,000 Germans suffers from a compromised immune system due to chemotherapy or other immune suppressive treatments. We noticed an unexpectedly high proportion of immune suppressed patients among those treated for aortic aneurysms in our institution (88 out of 224) which is significantly higher than would be expected (p < 0.001, chi-square test for given probabilities). Of 224 patients, 174 showed hypertension with positive correlation to preoperative aorta ascending diameter (p = 0.035). Eighty-eight patients had cytostatic therapy in the past and a positive correlation with the preoperative diameter of the ascending aorta (p = 0.007).

Conclusion: The potential effect of such therapies on the development of an aortic aneurysm has not yet been analyzed and needs further study. At present, it can only be speculated as to whether immunosuppressive drugs may damage the components of the aortic wall directly or whether it is owing to adverse effects on blood pressure and alteration of lipoproteins for instance.

No conflict of interest has been declared by the author(s).