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Aortic Diseases Guidelines

ESC Clinical Practice Guidelines

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).

Diseases of the Aorta
Acute Cardiac Care
CV Surgery - Aorta
Guidelines version available to download
Published in 2014
Reference Eur Heart J 2014;35:2873-2926 - Eur Heart J doi:10.1093/eurheartj/ehu281
Published in 2015
Reference Aortic Corrigendum T3
Published in 2014
Reference ESC Guidelines on Aortic Diseases Web Addenda
Published in 2014
Reference 2014 Take Home Messages & Gaps in Evidence
Published in 2014
Reference Pocket Guidelines Abriged version
Published in 2014
Reference Aortic Pocket Guidelines Mobile App
Published in 2014
Reference 56 Slides 2014 Aortic Diseases
Published in 2016
Reference Aorta Summary Card Online
Published in 2014
Reference 36 CME Questions
Table of contents: Full Text (ESC Clinical Practice Guidelines)



The normal and the ageing aorta

Assessment of the aorta

  1. Clinical examination
  2. Laboratory testing
  3. Imaging
    1. Chest X-ray
    2. Ultrasound
    3. Computed tomography
    4. Positron emission tomography/computed tomography
    5. Magnetic resonance imaging
    6. Aortography
    7. Intravascular ultrasound
  4. Assessment of aortic stiffness

Treatment options

  1. Principles of medical therapy
  2. Endovascular therapy
    1. Thoracic endovascular aortic repair
    2. Abdominal endovascular aortic repair


  1. Ascending aorta
  2. Aortic arch
  3. Thoracoabdominal aorta
  4. Abdominal aorta

Acute thoracic aortic syndromes

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

Aortic aneurysms

  1. Thoracic aortic aneurysms
  2. Abdominal aortic aneurysm
    1. Definition
    2. Risk factors
    3. Natural history
    4. Diagnosis
    5. Abdominal aortic aneurysm repair
    6. Long-term prognosis and follow-up of aortic aneurysm repair

Genetic diseases affecting the aorta

  1. Chromosomal and inherited syndromic thoracic aortic aneurysms and dissection
  2. Aortic diseases associated with bicuspid aortic valve
  3. Coarctation of the aorta

Atherosclerotic lesions of the aorta

  1. Thromboembolic aortic disease
  2. Mobile aortic thrombosis
  3. Atherosclerotic aortic occlusion
  4. Calcified aorta
  5. Coral reef aorta


  1. Definition, types, and diagnosis
  2. Treatment

Aortic tumours

  1. Primary malignant tumours of the aorta

Long-term follow-up of aortic diseases

  1. Chronic aortic dissection
  2. Follow-up after thoracic aortic intervention
  3. Follow-up of patients after intervention for abdominal aortic aneurysm

Gaps in evidence


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


Previous version available to download
Published in 2001
Reference Eur Heart J; 22:1642-1681