Surveillance for moderate-sized thoracic aortic aneurysms: Equality is the goal

Comprehensive clinical and imaging-based surveillance represents a fundamental aspect in the management of thoracic aortic aneurysms (TAAs), affording the opportunity to identify intermediate-sized TAAs before the onset of worrying symptoms or devastating acute aortic dissection/rupture. Currently, size-based indices are favored as the major determinants driving patient selection for surgery, as supported by aortic guidelines, although it is recognized that smaller subthreshold TAAs may still confer substantial risks. Prophylactic aortic surgery can be offered within set timeframes at dedicated aortic centers with excellent outcomes, to mitigate the threat of acute aortic complications associated with a repeatedly deferred intervention. In this commentary, we discuss a recent article from the Journal of Cardiac Surgery that highlights important socioeconomic disparities in TAA surveillance and follow-up.