



Managing At-Risk Patients

Patients at risk for thoracic aortic disease must be screened with CT, MRI, or, in some cases, echocardiography to identify issues before a catastrophic presentation occurs. Treatment in stable, asymptomatic patients carries far less risk than treatment in catastrophic situations. Clinicians must recognize key risk factors, including:

History of uncontrolled high blood pressure.
Presence of a connective tissue disorder such as Marfan syndrome, Ehlers-Danlos syndrome (vascular type), Loeys-Dietz syndrome, and Turner syndrome, among others.
Family history of aortic aneurysm or aortic dissection (even without a history of connective tissue disorder).
Personal or family history of bicuspid aortic valve or recent aortic manipulation.

“Awareness of the importance of thoracic aortic diseases and their varied presentations has been lacking.”

Family history is a critical tool to identify undiagnosed cases. First-degree relatives of any patient who has a thoracic aortic aneurysm or aortic dissection should be screened for the presence of thoracic aortic disease. Patients at high risk should be screened for the presence of thoracic aortic dilatation. Patients who are identified with asymptomatic or symptomatic thoracic aortic diseases should be referred to cardiovascular surgeons or cardiologists with expertise in thoracic aortic disease.

Other Guideline Highlights

Aortic dissection involving the ascending aorta is considered a life-threatening emergency that should be treated surgically. Aortic dissection involving the descending thoracic aorta may be managed with medications that control the blood pressure and heart rate unless malperfusion or life-threatening complications develop. Additional medical therapy may include statins to lower elevated cholesterol levels. Furthermore, less invasive endovascular techniques may be an option in select patients.

The new guidelines also include a series of algorithms to improve the early diagnosis of aortic dissection. The hope is that these algorithms will be of use to emergency physicians. For further information on thoracic aortic disease, physicians can visit



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Coady MA, Ikonomidis JS, Cheung AT, et al. Surgical Management of Descending Thoracic Aortic Disease: Open and Endovascular Approaches. A Scientific Statement From the American Heart Association. Circulation. 2010 Jun 7. [Epub ahead of print].