2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease
The 2022 guideline is the first ACC/AHA document to treat the aorta as one organ from root to bifurcation, and it is more surgical in temperament than the aortic chapters of the ESC's 2024 peripheral and aortic guideline. Its signature moves are the lowering of the elective repair threshold for ascending aneurysms to 5.0 cm in experienced multidisciplinary aortic centres (with earlier surgery for heritable aortopathy or aortic-size index criteria), the systematic use of genetic testing and family screening in heritable thoracic aortic disease, and shared decision-making around pregnancy. Where randomised evidence exists it is largely in the abdominal aorta and in type B dissection — those trials are grouped below.
This guideline cites 5 of the 199 landmark trials in our Cardiology register.
Abdominal aortic aneurysm — repair thresholds & surveillance2
- 2016EVAR-1Cardiology · Vascular · Aortic aneurysmUK Endovascular Aneurysm Repair Trial 1 — 15-year follow-up
- 1998UK Small Aneurysm TrialCardiology · Vascular · Aortic aneurysmUK Small Aneurysm Trial — early elective surgery versus ultrasonographic surveillance
Ruptured abdominal aortic aneurysm — endovascular vs. open1
- 2014IMPROVECardiology · Vascular · Aortic aneurysmImmediate Management of the Patient with Rupture: Open Versus Endovascular Repair
Type B aortic dissection1
- 2013INSTEAD-XLCardiology · Vascular · Aortic dissectionInvestigation of Stent Grafts in Aortic Dissection — eXtended Long-term follow-up
Medical therapy — blood-pressure control1
- 2015SPRINTCardiology · HTN · BP targetSystolic Blood Pressure Intervention Trial