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Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes

Abstract

The aorta is the ‘greatest artery’, through which oxygenated blood is delivered from the left ventricle to end organs with each cardiac cycle (200 million litres of blood transported in an average lifetime). The aorta can be affected by a wide spectrum of acute factors (such as cocaine use, weight lifting and trauma) and chronic acquired and/or genetic conditions (such as systemic arterial hypertension and phaeochromocytoma), which variously lead to increased aortic wall stress. The medial layer of the aorta can also be subject to abnormalities (such as Marfan syndrome, bicuspid aortic valve, inflammatory vasculitis, atherosclerosis and infections). Despite important advances in diagnostic and therapeutic interventions, data derived from registries and population-based studies highlight that the burden of aortic diseases remains high. Therefore, specific resources need to be allocated to design and implement preventive strategies (healthy lifestyles, modifications to cardiovascular risk factors, and educational and screening programmes) at individual and community levels. In this Review, we discuss the epidemiology, management and outcomes of the most common aortic diseases, namely, aortic aneurysms and acute aortic syndromes.

Key points

  • The aorta can be affected by various congenital and acquired diseases, either acutely or chronically, and involving the thoracic and/or abdominal components.

  • Despite remarkable progress in diagnostic and therapeutic techniques, the global burden of aortic diseases remains high.

  • Designing and implementing prevention and screening programmes at the individual and population levels are required.

  • Advances in genetics, proteomics and imaging might allow more precise diagnosis, prevention and treatment in the future.

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Fig. 1: The structure and anatomy of the aorta.
Fig. 2: Imaging of aortic aneurysms.
Fig. 3: Effect of aortic aneurysm size on the risk of complications.
Fig. 4: Acute aortic syndromes.
Fig. 5: Imaging of acute aortic syndromes.
Fig. 6: Classification schemes for aortic dissection.
Fig. 7: Aortic dissections in the UK.
Fig. 8: Aortic dissection: management and mortality over time in the IRAD.
Fig. 9: Traumatic aortic pseudoaneurysm.

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Bossone, E., Eagle, K.A. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol 18, 331–348 (2021). https://doi.org/10.1038/s41569-020-00472-6

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