Management and Treatment for Ectasia of the Descending Thoracic Aorta

Definition and Diagnosis

Aortic ectasia is defined as dilatation of <50% over normal aortic diameter, whereas thoracic aortic aneurysm (TAA) is diagnosed when there is at least 50% enlargement of the aortic lumen, or when the diameter is more than two standard deviations above the mean for the patient's sex and age 3
Normal thoracic aorta diameter varies from 3.5-4.0 cm at the aortic root, tapering to 2.4-2.7 cm at the diaphragm level 3

Aggressive management of cardiovascular risk factors is recommended for all patients with aortic ectasia, according to the American Heart Association 4, 2
Hypertension control is essential to reduce wall stress and slow progression of dilatation, as recommended by the European Society of Cardiology 4, 5
Beta-blockers are typically first-line agents for blood pressure control in aortic disease to reduce aortic wall stress, as suggested by the American College of Cardiology 4, 5

Comprehensive imaging with CT or MRI is recommended at diagnosis to establish baseline measurements and rule out associated pathologies, according to the European Heart Journal 2
Transthoracic echocardiography (TTE) is recommended at diagnosis to assess aortic valve anatomy and function, but is not sufficient for complete evaluation of the descending thoracic aorta, as stated by the European Society of Cardiology 2
For stable descending thoracic aortic ectasia, follow-up imaging with CT or MRI is recommended at 6-12 month intervals initially, as recommended by the European Heart Journal 6, 7

Elective repair is recommended when the descending thoracic aorta diameter reaches ≥55 mm, according to the American College of Cardiology and the European Society of Cardiology 2, 1
Earlier intervention (at diameter <55 mm) may be considered in patients with risk factors for rupture, including connective tissue disorders, as recommended by the European Heart Journal 7
When intervention is indicated and anatomy is suitable, thoracic endovascular aortic repair (TEVAR) is recommended over open repair for descending thoracic aortic aneurysms, as suggested by the European Society of Cardiology 2

In patients with limited life expectancy (<2 years) or at high surgical risk, continued surveillance rather than intervention may be appropriate even at larger diameters, according to the European Heart Journal and the American College of Cardiology 2, 1
Factors that increase perioperative risk include advanced age, renal insufficiency, chronic obstructive pulmonary disease, and previous stroke, as stated by the American College of Cardiology 1
After TEVAR, follow-up imaging is recommended at 1 and 12 months post-operatively, then yearly until the fifth post-operative year, as recommended by the European Heart Journal 2