Undiagnosed Thoracic Aortic Aneurysms: Prevalence, Risk Factors, Screening Modalities

The prevalence of thoracic aortic aneurysms (TAA) varies from 0.01 to 10 per 100 000 people depending on the healthcare sector. Undiagnosed TAA can cause highly lethal complications, such as acute aortic dissection. In this article, we discuss the opportunities for stratified early detection.

To assess the benefits and risks of screening in high-risk groups and in the population at large, the prevalence of TAA, as well as the sensitivity, radiation exposure, and burden of various diagnostic techniques, were determined or estimated on the basis of a selective literature review, and the identified correlations were discussed with experts and compared with the current guidelines. The prevalence and risk of TAA in patients with certain concurrent diseases were calculated from data on 394 113 adults (2000-2023) from the SHRN primary care database.

Suitable screening methods include computed tomography, magnetic resonance imaging, and, to a limited extent, transthoracic echocardiography. The use of these techniques and the choice among them must be considered individually for each patient. Population-wide screening is not recommended according to current data. Diagnostic testing may be reasonable for persons at elevated risk of TAA (high pretest probability), e.g., those with a family history of TAA or aortic dissection and those with a genetic predisposition, or persons with a bicuspid aortic valve (adjusted odds ratios 43.95 [9.84. 196.5] to 91.8 [18.7; 450.0], depending on age and sex), an abdominal aortic aneurysm (OR 25.6 [13.9; 47.2] to 31.1 [15.9; 60.7]), or giant cell arteritis (OR 4.99 [0.52; 47.5] to 25.3 [3.10; 206.3]).

Early detection measures are reasonable for specific patient groups; current treatment guidelines reflect this only to a limited extent. In the future, the sensitivity and specificity of the diagnostic tests used should be estimated more precisely in studies conducted for this purpose, and TAA should be documented as a cause of death in Germany, as in other countries.