New Aortic Disease Guidelines for Diagnosis and Management

March 12, 2024

Written by Nickolas Srica

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This summary of clinical guideline updates for the diagnosis and management of aortic diseases includes recommendation changes surrounding the importance of multidisciplinary care teams and referral to centers with higher case volumes when feasible for potentially better outcomes, transthoracic echocardiogram (TTE) at time of transthoracic aortic aneurysm (TAA), and updated aneurysm size recommendations for repair, to name a few. Keep reading for more details!

Aortic dissections can really tear you up inside…
This was a brief synopsis of some of the more recent guidelines from the American College of Cardiology (ACC) and American Heart Associated (AHA) for the diagnosis and management of aortic diseases. Read below for some of the pertinent highlights!

• Referring to centers with multidisciplinary expert teams and higher case volumes (>30-40 cases per year) when feasible may lead to better outcomes in aortic dissection and TAA repair.
• All patients diagnosed with TAA should receive a TTE to assess aortic valve structure and function.
• Though it is still strongly recommended that patients with aortic aneurysms ≥5.5 cm receive repair, a major change is the recommendation that it may now be reasonable for certain low surgical risk patients to consider repair at 5.0 cm.
• First-degree relatives of all patients with aortic dissection or aortic root/ascending aortic aneurysms should be screened.
• Pregnant patients with known aortic disease should be screened during pregnancy and the post-partum period to catch complications early.
• Avoiding intense isometric exercises and heavy weightlifting is now recommended in patients with significant aortic disease.

How will this change my practice?
It’s important to remember that the emergency department is the place that many patients and their families rely on for clinical advice and follow up recommendations. I’ll continue to reach out to my vascular specialists early for these patients to improve both their acute care and follow up planning.

Editor’s note: We regularly uncover incidental findings on CT. We need to know which patients need immediate surgery vs urgent follow up. ~Clay Smith

Source
Diagnosis and Management of Aortic Diseases. JAMA. 2023 Dec 21;331(4):352-353. doi: 10.1001/jama.2023.23668.