Thoracic aortic aneurysms: state of the art and current controversies

INTRODUCTION: Complications of thoracic aortic aneurysms (TAA), including aortic rupture and dissection, are often catastrophic and prophylactic intervention can be lifesaving. Controversies exist regarding the standardization of aortic imaging techniques, the best metric for assessing aortic risk and the optimal threshold for intervention. Areas covered: This review summarizes recent temporal trends in TAA disease, provides an overview of the role of multi-modality imaging in diagnosis of the disease, and reviews controversies around surgical thresholds for intervention and medical therapies in the management of TAA disease. Expert commentary: While death from TAA appears to be declining, it remains an important cause of morbidity and mortality. Multi-modality imaging has revolutionized the diagnosis and follow up of TAAs but knowledge of the nuances of how images are acquired and measurements made are important. Emerging evidence suggests that the cross sectional area to height ratio may be a better measure of aortic risk, especially in those who do not meet current surgical thresholds. The use of medications to delay disease progression is controversial, but given the overall good safety profile of medications such as beta-blockers and angiotensin receptor blockers, they should be considered in all patients with TAA disease.