Managing Thoracic Aortic Disease

Thoracic aortic diseases result in more than 40,000 deaths per year in the United States, but this estimate is likely low because many of these deaths will result from an undiagnosed aortic rupture or dissection and will be labeled as a heart attack. Most thoracic aortic diseases are asymptomatic until they present with catastrophic aortic dissection, aortic rupture, stroke, or other complications associated with a high likelihood of mortality or major morbidity. Acute aortic dissection may present with atypical symptoms and findings, making a diagnosis even more difficult. Awareness of the importance of thoracic aortic diseases and their varied presentations has been lacking. In the April 2, 2010 issues of Circulation and the Journal of American College of Cardiology, my colleagues and I developed guidelines to provide physicians with recommendations for the early diagnosis and management of thoracic aortic disease. The guidelines represent a consensus of 10 co-sponsoring specialty organizations with an additional endorsing imaging organization; it also utilized input of two additional specialty organizations. Scientific and clinical advances in medicine drove the development of the guidelines, significantly impacting the diagnosis and management of aortic dissection, aortic aneurysms, and other forms of thoracic aortic disease. For example, imaging techniques have improved the ability to make diagnoses. A diagnosis of thoracic aortic disease requires dedicated imaging (CT or MRI, and in some cases, echocardiography); standard chest radiography is not sufficient. Improved surgical and endovascular methods of treating thoracic aortic diseases and methods of preserving other organs during and after surgical or endovascular interventions have also improved the management of thoracic aortic disease. Managing At-Risk Patients Patients at risk for thoracic...