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Published on: September 19, 2018
Thoracic aortic aneurysm clinically pertinent controversies and uncertainties
John A Elefteriades1, Emily A Farkas
1Cardiac Surgery, Yale University School of Medicine, Boardman 2, 333 Cedar Street, New Haven, Connecticut 06510, USA. john.elefteriades@yale.edu
Journal of the American College of Cardiology
|February 27, 2010
Summary
Thoracic aortic aneurysms (TAA) require comprehensive assessment and timely intervention, often before rupture. Current treatments show limited benefit, highlighting the need for better biomarkers and non-size-based criteria for managing this genetic disease.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Medical Imaging
Background:
- Thoracic aortic aneurysm (TAA) is an increasingly recognized cause of death, with a growing incidence.
- Accurate assessment of aortic size is challenging due to imaging limitations.
- TAA is a slow-growing but virulent disease with significant morbidity and mortality.
Purpose of the Study:
- To address clinical controversies and uncertainties in the diagnosis and management of TAA.
- To review current evidence regarding intervention criteria, medical treatments, and emerging therapies.
- To highlight the need for improved diagnostic tools and predictive biomarkers for TAA.
Main Methods:
- Review of existing literature and clinical guidelines on TAA.
- Analysis of epidemiological data and aortic growth rates.
- Evaluation of evidence from key clinical trials on TAA interventions.
Main Results:
- Accurate TAA size estimation requires multimodal imaging (echocardiography, CT/MRI).
- Surgical intervention at 5.0-5.5 cm diameter is recommended to prevent rupture; symptomatic aneurysms require resection regardless of size.
- Medical therapies (beta-blockers, ARBs) and endovascular repair show unproven benefits; biomarkers and non-size criteria are under development.
- Acute aortic dissections are often preceded by specific exertional or emotional events.
Conclusions:
- TAA management requires a multidisciplinary approach, integrating imaging, clinical judgment, and evolving evidence.
- Further research is needed to identify reliable biomarkers and refine intervention criteria for TAA.
- Despite challenges, understanding the genetic basis and pathophysiology of TAA is advancing treatment strategies.
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