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Thoracic aortic aneurysm: unlocking the “silent killer” secrets

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  • Controversies in Surgery for Thoracic Aorta
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Abstract

Thoracic aortic aneurysm (TAA) is an increasingly recognized condition that is often diagnosed incidentally. This review discusses ten of the most relevant epidemiological and clinical secrets of this disease; (1) the difference in pathogenesis between ascending and descending TAAs. TAAs at these two sites act as different diseases, which is related to the different embryologic origins of the ascending and descending aorta. (2) The familial pattern and genetics of thoracic aneurysms. Syndromic TAAs only explain 5% of the pattern of inheritance. (3) The effect of female sex on TAA growth and outcome. Females have been found to have worse outcomes compared to males. (4) Guilt by Association. TAAs are associated with abdominal aortic aneurysms, intracranial aneurysms, bicuspid aortic valve, and inflammatory disorders. (5) Natural history of TAAs. Important findings have been made regarding the expansion rate (in relation to familial pattern, location and size), and also regarding the risk of rupture or dissection. (6) The aortic size paradox. Size only is not a sufficient predictor of risk of dissection. (7) Biomarker void. Although many serum biomarkers have been studied, imaging remains the only reliable method for diagnosis and follow-up. (8) Indications for repair. Decisions are made depending on symptoms, location, size, and familial patterns. (9) Types of repair. Both open and endovascular repair options are available for certain TAAs. (10) Medical treatment. The efficacy of prescribing beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers remains dubious.

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Fig. 1

(Reprinted with permission from Brownstein et al. [23])

Fig. 2

(Reprinted with permission from Elefteriades et al. [30])

Fig. 3

(Modified with permission from Coady et al. [42])

Fig. 4

(Reprinted with permission from Elefteriades and Farkas et al. [6])

Fig. 5

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Authors and Affiliations

  1. Aortic Institute at Yale-New Haven, Yale University School of Medicine, 789 Howard Avenue, Clinic Building CB317, P.O. Box 208039, New Haven, CT, USA

    Ayman A. Saeyeldin, Camilo A. Velasquez, Syed Usman B. Mahmood, Adam J. Brownstein, Mohammad A. Zafar, Bulat A. Ziganshin & John A. Elefteriades

  2. Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia

    Bulat A. Ziganshin

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  1. Ayman A. Saeyeldin
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  2. Camilo A. Velasquez
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  3. Syed Usman B. Mahmood
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  4. Adam J. Brownstein
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  5. Mohammad A. Zafar
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  6. Bulat A. Ziganshin
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  7. John A. Elefteriades
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Correspondence to John A. Elefteriades.

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Saeyeldin, A.A., Velasquez, C.A., Mahmood, S.U.B. et al. Thoracic aortic aneurysm: unlocking the “silent killer” secrets. Gen Thorac Cardiovasc Surg 67, 1–11 (2019). https://doi.org/10.1007/s11748-017-0874-x

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  • DOI: https://doi.org/10.1007/s11748-017-0874-x

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