Aortic aneurysm
Also known as: AAA · abdominal aortic aneurysm · aortic dissection · thoracic aortic aneurysm
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2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease
ACC/AHA · 2022
Aortic aneurysm in the US is covered by this comprehensive aortic disease guideline, which spans asymptomatic, stable symptomatic and acute aortic syndrome presentations. Relevant to aneurysm care, it addresses imaging acquisition and measurement standards, surveillance intervals before and after intervention, genetic evaluation and family screening, medical therapy, and thresholds for endovascular or open surgical repair. Metadata record only.
- Issued in 2022 by the AHA/ACC Joint Committee on Clinical Practice Guidelines and endorsed by AATS, ACR, SCA, SCAI, SIR, STS, SVM and SVS. source
- Sets out recommended approaches to CT, MRI and echocardiographic image acquisition, aortic measurement and reporting, and surveillance frequency. source
- Recommends aortic imaging screening of first-degree relatives for patients with aortic root or ascending aortic aneurysm, or aortic dissection. source
2024 ESC Guidelines for the management of peripheral arterial and aortic diseases
European Society of Cardiology (ESC), endorsed by EACTS, VASCERN and ESVM · 2024
European guidance on aortic aneurysm now sits inside the 2024 ESC combined peripheral arterial and aortic diseases guideline, which absorbed the previous standalone aortic diseases document. The aortic sections address diagnosis, surveillance and treatment of aneurysmal disease, covering both atherosclerotic aortic disease and non-atherosclerotic genetic aortopathies. Metadata record only.
- Published August 2024; consolidates and updates the 2014 ESC aortic diseases guideline alongside the 2017 peripheral arterial diseases guideline. source
- Aortic aneurysm is addressed within the aortic diseases sections, with guidance on diagnosis, surveillance and treatment. source
- Focus is mainly atherosclerotic disease but non-atherosclerotic genetic conditions affecting the aorta are also covered. source
US vs EU key differences
- The 2022 US guideline lowered the surgical threshold for sporadic aortic root and ascending aortic aneurysms from 5.5 cm to 5.0 cm in selected patients, but only at centres with a multidisciplinary aortic team and experienced surgeons; 5.5 cm remains the threshold elsewhere. source
- The 2024 ESC guideline states the ascending aorta threshold as a diameter of 55 mm or more for a Class I surgical recommendation, and prefers valve-sparing approaches at experienced centres. source
- Abdominal aneurysm screening is spelled out in detail by the ESC: men 65 or older who have smoked, all men 75 or older, women 75 or older who smoke or are hypertensive, and — upgraded to Class I — first-degree relatives aged 50 or older of patients with an abdominal aortic aneurysm. source
- The US guideline emphasises family screening on the thoracic side instead, recommending aortic imaging of first-degree relatives of patients with aortic root or ascending aortic aneurysm or aortic dissection, and allows indexing of aortic diameter to height or body surface area in patients of unusual size. source
What changed recently
- EU2014 (aortic diseases) / 2017 (peripheral arterial diseases) → 20242024-08-30
For the first time the ESC merges its 2014 aortic diseases and 2017 peripheral arterial diseases guidelines into a single document, treating the arterial system as a whole. It sets a Class I threshold of 55 mm maximum aortic diameter for surgery in both tricuspid and bicuspid aortic valve patients, with 50 mm for the bicuspid root phenotype, and pushes management towards experienced multidisciplinary aortic teams.
source ↗curation confidence 90% - US2010 → 20222022-11-02
The 2022 guideline updates the 2010 thoracic aortic disease guideline and, for the first time, covers the thoracic and abdominal aorta in one document. In experienced multidisciplinary centres it lowers the repair threshold for sporadic root and ascending aneurysms to 5.0 cm in selected patients, and formalises body-size indexed measures such as aortic size index and aortic height index for smaller or taller patients.
source ↗curation confidence 90%
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