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Aortic Diseases

ESC Clinical Practice Guidelines

Topics: Diseases of the Aorta and Trauma to the Aorta and Heart

Summary

Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.

In addition to coronary and peripheral artery diseases, aortic diseases contribute to the wide spectrum of arterial diseases: aortic aneurysms, acute aortic syndromes (AAS) including aortic dissection (AD), intramural haematoma (IMH), penetrating atherosclerotic ulcer (PAU) and traumatic aortic injury (TAI), pseudoaneurysm, aortic rupture, atherosclerotic and inflammatory affections, as well as genetic diseases (e.g. Marfan syndrome) and congenital abnormalities including the coarctation of the aorta (CoA).

30/08/2014 00:00:00

Current versions available to download

Publication dateVersionsReferencesSize
2014Web AddendaESC Guidelines on Aortic Diseases Web Addenda3 MB
2014Full TextEur Heart J doi:10.1093/eurheartj/ehu281

Authors

R. Erbel FESC (Chairperson), Victor Aboyans (Chairperson), Edduardo Bossone (Itatly), Roberto Di Bartolomeo (Italy),Holger Eggebrecht (Germany), Arturo Evangelista (Spain), Volkmar Falk (Switzerland), Herbert Franck  (Austria), Oliver Gaemperli (Switzerland), Martin Grabenwoeger (Austria), Axel Haverich (Germany), Bernard Iung (France), Anathasios John Manolis (Greece), Folkert Meijboom (Netherlands), Christoph  A. Nienaber (Germany), Marco Roffi (Switzerland), Hervé Rousseau (France), Udo Sechtem (Germany), Per Anton Sirnes (Norvay), Regula S. von Allmen (Switzerland) and Christi J.M. Vrints (Belgium)

Declarations of Interest of the experts involved in the elaboration of the document

Endorsed by:


Table of contents: Full Text (ESC Clinical Practice Guidelines)

Preamble
Introduction

The normal and the ageing aorta

Assessment of the aorta

  • Clinical examination
  • Laboratory testing
  • Imaging
    • Chest X-ray
    • Ultrasound 
    • Computed tomography 
    • Positron emission tomography/computed tomography
    • Magnetic resonance imaging 
    • Aortography
    • Intravascular ultrasound
  •  Assessment of aortic stiffness

Treatment options

  • Principles of medical therapy
  • Endovascular therapy
    • Thoracic endovascular aortic repair
    • Abdominal endovascular aortic repair
Surgery
    • Ascending aorta
    • Aortic arch
    • Thoracoabdominal aorta
    • Abdominal aorta

Acute thoracic aortic syndromes

  • Definition
  • Pathology and classification
  • Acute aortic dissection
    • Definition and classification
    • Epidemiology
    • Clinical presentation and complications
    • Laboratory testing
    • Diagnostic imaging in acute aortic dissection
    • Diagnostic work-up
    • Treatment
  • Intramural haematoma
    • Definition
    • Diagnosis
    • Natural history, morphological changes, and complications
    • Indications for surgery and thoracic endovascular aortic repair
  • Penetrating aortic ulcer
    • Definition
    • Diagnostic imaging
    • Management
    • Interventional therapy
  • Aortic pseudoaneurysm
  • (Contained) rupture of aortic aneurysm
    • Contained rupture of thoracic aortic aneurysm
  • Traumatic aortic injury
    • Definition, epidemiology and classification
    • Patient presentation and diagnosis
    • Indications for treatment in traumatic aortic injury
    • Medical therapy in traumatic aortic injury
    • Surgery in traumatic aortic injury
    • Endovascular therapy in traumatic aortic injury
    • Long-term surveillance in traumatic aortic injury
  • Iatrogenic aortic dissection

Aortic aneurysms

  • Thoracic aortic aneurysms
  • Abdominal aortic aneurysm
    • Definition
    • Risk factors
    • Natural history
    • Diagnosis
    • Abdominal aortic aneurysm repair
    • Long-term prognosis and follow-up of aortic aneurysm repair

Genetic diseases affecting the aorta

  •  Chromosomal and inherited syndromic thoracic aortic aneurysms and dissection
  • Aortic diseases associated with bicuspid aortic valve
  • Coarctation of the aorta

Atherosclerotic lesions of the aorta

  • Thromboembolic aortic disease
  • Mobile aortic thrombosis
  • Atherosclerotic aortic occlusion
  • Calcified aorta
  • Coral reef aorta

Aortitis

  • Definition, types, and diagnosis
  • Treatment

Aortic tumours

  • Primary malignant tumours of the aorta

Long-term follow-up of aortic diseases

  • Chronic aortic dissection
  • Follow-up after thoracic aortic intervention
  • Follow-up of patients after intervention for abdominal aortic aneurysm

Gaps in evidence

Appendix

Web addenda – All web figures and web tables are available in the online addenda

References

Previous versions

Year Title
Journal Issue
2001
Aortic Dissection Eur Heart J 22:1642-1681