Thoracic aortic aneurysm is a potentially fatal, often asymptomatic dilation of the thoracic aorta (prevalence ~4.2%), with incidence of 5–10 per 100,000 person-years. [1-2] Approximately 60% involve the ascending aorta/arch, ~30% the descending aorta. [2] The most feared complication is aortic dissection or rupture, with rupture risk roughly doubling per 1 cm of growth above 5 cm. [1] Without timely intervention, approximately 50% of patients with TAA may progress to dissection. [3]
1. History
- Onset and character of pain: Chest pain, interscapular/back pain, or abdominal pain — ask about abrupt onset, severity, and "tearing/ripping" quality [2][4]
- Compressive symptoms: Hoarseness (recurrent laryngeal nerve), dysphagia (esophageal compression), dyspnea/stridor (tracheal/bronchial compression), plethora/edema (SVC compression) [2][5-6]
- Timing: Acute vs. chronic; progressive vs. sudden onset
- Triggers: Heavy lifting, Valsalva, cocaine/methamphetamine use, recent trauma or deceleration injury [5-6]
- Associated symptoms: Syncope, focal neurological deficits, limb weakness/ischemia, hemoptysis, hematemesis [2]
- Important negatives: Absence of pain does not exclude TAA — most are asymptomatic and discovered incidentally on imaging [6-7]
2. Alarm Features
- Abrupt onset of severe chest/back pain maximal at onset (classic "aortic pain") [2][8]
- Pulse deficit or SBP differential >20 mmHg between limbs [2]
- Hypotension or shock — suggests rupture, tamponade, or severe aortic regurgitation [2]
- New aortic regurgitation murmur with pain [2]
- Focal neurological deficit (stroke, paraplegia) with pain [2]
- Hemoptysis (aortobronchial fistula) or hematemesis (aortoesophageal fistula) [2][5]
- Malperfusion signs: Limb ischemia, oliguria/hematuria, bowel ischemia, myocardial ischemia [2]
- Syncope — may indicate carotid involvement or cardiac tamponade [2]
3. Medications
- Beta-blockers are first-line antihypertensives — reduce both BP and heart rate, decreasing aortic wall shear stress. Acute target SBP <120 mmHg or MAP <80 mmHg [2][9]
- ARBs (e.g., losartan) — may mitigate proteolysis pathways; reasonable adjunct, especially in Marfan syndrome [2][10]
- Statins — target inflammatory/atherosclerotic pathways; may reduce cardiovascular events [2]
- Opioids (e.g., morphine) preferred for acute pain control [9]
- Avoid vasodilators (e.g., hydralazine, nitroprusside without beta-blockade) — promote reflex tachycardia and increase aortic wall stress [9]
- Avoid anticoagulation/thrombolytics if dissection is suspected
- Cocaine/stimulants are contraindicated — associated with dissection even without other risk factors [4][6]
4. Diet
- Sodium restriction to support blood pressure control
- Heart-healthy diet (Mediterranean-style) to manage atherosclerotic risk factors
- Smoking cessation is critical — smoking accelerates aneurysm growth and increases dissection risk [2][11]
- Avoid excessive caffeine and stimulants that may transiently elevate BP
- Limit alcohol to reduce hypertension burden
5. Review of Systems
- Cardiovascular: Chest pain, palpitations, exertional dyspnea, syncope, claudication
- Neurological: Headache, visual changes, focal weakness, numbness (stroke/malperfusion)
- Respiratory: Dyspnea, stridor, cough, hemoptysis
- GI: Dysphagia, abdominal pain, GI bleeding (aortoenteric fistula)
- Genitourinary: Oliguria, hematuria (renal malperfusion)
- Musculoskeletal: Back/interscapular pain, features of connective tissue disorders (joint hypermobility, pectus deformity, tall stature)
- Constitutional: Fever, chills, night sweats (raise suspicion for mycotic aneurysm or aortitis) [5]
6. Collateral History and Family History
- Family history of TAA, aortic dissection, or unexplained sudden death in first-degree relatives — present in 13%–19% of non-syndromic TAA patients [6]
- Screen for heritable thoracic aortic disease (HTAD): Marfan, Loeys-Dietz, vascular Ehlers-Danlos, familial TAA syndrome [2][11]
- Bicuspid aortic valve in family members
- Social history: Cocaine/methamphetamine use, smoking history, heavy weightlifting [5-6]
- Patients presenting with TAA at age <50, clinical features of syndromic aortopathy, or positive family history should be referred for genetic assessment [11]
7. Risk Factors
- Hypertension — most common comorbidity, present in >80% of cases [8][11]
- Smoking [2][6]
- Hypercholesterolemia/atherosclerosis [2]
- Male sex (~70% of TAA/dissections in men), though women have 3× higher risk of dissection/rupture at smaller sizes [11]
- Bicuspid aortic valve [2][6]
- Genetic syndromes: Marfan, Loeys-Dietz, vascular Ehlers-Danlos, Turner syndrome [6]
- Familial thoracic aortic aneurysm and dissection syndrome [6]
- Inflammatory vasculitis: Takayasu, giant cell arteritis, Behçet [5-6]
- COPD [6][11]
- Prior cardiac surgery [10]
- Cocaine/stimulant use [4][6]
- Pregnancy, polycystic kidney disease, coarctation of the aorta [6]
8. Differential Diagnosis
- Aortic dissection (Type A or B) — the most feared complication and mimic; may coexist [1-2]
- Acute coronary syndrome — chest pain overlap; ECG and troponins help differentiate [8]
- Pulmonary embolism — acute dyspnea and chest pain; D-dimer and CTA distinguish
- Pericarditis/tamponade — positional pain, friction rub, pulsus paradoxus
- Esophageal rupture (Boerhaave syndrome) — severe chest/back pain with vomiting
- Mediastinal mass/tumor — compressive symptoms may mimic large TAA [6]
- Musculoskeletal chest pain — diagnosis of exclusion
- Penetrating aortic ulcer (PAU) and intramural hematoma (IMH) — part of the acute aortic syndrome spectrum; managed similarly to dissection [1]
9. Past Medical History
- Prior aortic aneurysm (thoracic or abdominal) — TAA patients have modestly increased incidence of AAA and cerebral aneurysms [2]
- Known bicuspid aortic valve or prior aortic valve surgery [2][6]
- Connective tissue disorders (Marfan, Loeys-Dietz, Ehlers-Danlos)
- Prior aortic dissection — chronic dissection accounts for 30%–40% of patients requiring repair [11]
- Prior cardiac or aortic surgery — increases risk of dissection and spinal cord ischemia during TAA repair [5][10]
- Hypertension history and adequacy of control
- Inflammatory/autoimmune conditions (vasculitis, polycystic kidney disease)
10. Physical Exam
- Vital signs: Blood pressure in both arms — SBP differential >20 mmHg is a high-risk finding [2][9]
- Auscultation: New diastolic murmur of aortic regurgitation (root/ascending dilation causing incomplete valve closure) [2]
- Peripheral pulses: Assess for pulse deficits in all extremities (malperfusion) [9]
- Neurological exam: Focal deficits (stroke from carotid involvement), paraplegia (spinal malperfusion) [2]
- Marfanoid habitus: Tall stature, arachnodactyly, pectus deformity, lens subluxation, joint hypermobility
- Signs of tamponade: JVD, muffled heart sounds, hypotension (Beck's triad)
- Abdominal exam: Pulsatile mass (concomitant AAA), tenderness
- Skin: Livedo reticularis, mottling (distal embolization or malperfusion)
11. Lab Studies
- D-dimer: Elevated in acute aortic syndrome; a normal D-dimer in a low-risk patient has high negative predictive value. The triad of normal ECG + normal troponin + elevated D-dimer is a warning pattern for acute aortic syndrome [8]
- Troponin: To rule out ACS; may be elevated if dissection involves coronary ostia [8]
- CBC: Baseline; anemia may suggest rupture
- BMP/Creatinine: Renal function (malperfusion, contrast planning)
- Lactate: Elevated in malperfusion/shock
- Type and screen/crossmatch: If surgical intervention anticipated
- Coagulation studies: PT/INR, PTT — preoperative planning
- Lipid panel: Cardiovascular risk stratification for chronic management
12. Imaging
- CTA of chest, abdomen, and pelvis — gold standard for diagnosis and treatment planning; highly sensitive and specific. Recommended urgently when clinical suspicion is high [4-5][7]
- ECG-gated technique reduces motion artifact of the ascending aorta [1-2]
- Non-contrast series first to identify intramural hematoma [2]
- Chest X-ray: May show mediastinal widening, abnormal aortic contour, left pleural effusion — but may be normal; insufficient to exclude TAA [4-5][12]
- TTE: Recommended at diagnosis to assess aortic valve anatomy/function and proximal aortic diameters; limited for arch and descending aorta [2][5]
- TEE: Second-line; useful for differentiating dissection, IMH, and PAU; contraindicated with esophageal pathology [5]
- MRI/MRA: Alternative when CT is contraindicated (contrast allergy, renal insufficiency); excellent sensitivity/specificity but slower acquisition [4-5]
- When imaging is unnecessary: Stable, small (<4 cm), incidentally discovered dilations in low-risk patients may be followed with TTE alone if the proximal ascending aorta is well visualized [2][13]
13. Special Tests
- Aortic Dissection Detection Risk Score (ADD-RS): Pretest probability tool using 3 categories — predisposing conditions, pain features, exam findings. Score 0 = low risk, 1 = intermediate, ≥2 = high risk. Class I recommendation per ACC/AHA [2][8]
- Aortic size indices (2022 ACC/AHA): Cross-sectional aortic area/height ratio ≥10 cm²/m, aortic size index ≥3.08 cm/m², or aortic height index ≥3.21 cm/m — alternate surgical thresholds, particularly important in women and smaller patients [14]
- Genetic testing: Recommended for patients <50 years, syndromic features, or positive family history [11]
- Point-of-care ultrasound (POCUS): Bedside TTE in the ED can identify pericardial effusion, aortic regurgitation, or a dissection flap [4][8]
14. ECG
- Often normal or nonspecific — does not exclude acute aortic syndrome [8-9]
- ST-segment changes: May mimic STEMI if dissection involves coronary ostia (most commonly RCA → inferior STEMI pattern) [2][4]
- LVH pattern: Suggests chronic hypertension (a major risk factor)
- Critical pearl: The triad of normal ECG + normal troponin + elevated D-dimer should raise suspicion for acute aortic syndrome rather than ACS [8]
- Danger: Misdiagnosis as ACS leading to anticoagulation/thrombolysis in the setting of unrecognized dissection is catastrophic
15. Assessment
- Most TAAs are asymptomatic and discovered incidentally on imaging obtained for other reasons [6-7]
- Severity stratification is based on:
- Aneurysm diameter (risk inflection point at 6.0 cm; annual dissection risk <1%/year for <5.5 cm, ~1.15%/year for 5.5–5.9 cm, 4.1%/year for ≥6.0 cm) [1][15]
- Growth rate (>0.5 cm/year is high-risk) [11][16]
- Etiology (genetic aortopathies carry higher risk at smaller sizes) [11][17]
- Sex (women rupture/dissect at smaller sizes and have higher mortality) [11]
- Atypical presentations: Abdominal pain, jaw/neck pain (arch aneurysms), isolated hoarseness, or distal embolization without pain [5-6]
- Complications: Dissection, rupture, aortic regurgitation/heart failure, malperfusion syndromes, aortobronchial/aortoesophageal fistula, thromboembolism [2][11]
16. Treatment Plan
Acute Stabilization (if symptomatic/dissecting)
- ABCs, large-bore IV access, type and crossmatch
- IV beta-blocker (esmolol or labetalol) — target HR <60 bpm, SBP <120 mmHg [9]
- IV opioids for pain control [9]
- Avoid vasodilators without prior beta-blockade [9]
- Emergent surgical consultation — Type A dissection is almost always a surgical emergency [1]
Chronic Medical Management
- Blood pressure control: SBP goal ≤130/80 mmHg; consider more intensive SBP <120 mmHg if tolerated [2]
- Beta-blockers are preferred first-line antihypertensives [2][9]
- ARBs as adjunct or alternative [2]
- Statins for atherosclerotic risk reduction [2]
- Smoking cessation — critical modifiable risk factor [2]
- Exercise counseling: Avoid heavy isometric exercise, competitive sports, and Valsalva maneuvers [6]
Surgical Intervention Thresholds (per 2022 ACC/AHA) [1][11][16-17]
- Open surgical repairTEVARJACC + 1[2][18]
17. Disposition
Admission Criteria
- Acute aortic syndrome (dissection, IMH, PAU) — ICU admission [2][9]
- Symptomatic TAA (new pain, compressive symptoms, hemoptysis) [11]
- Hemodynamic instability, malperfusion, or shock [2]
- TAA meeting surgical threshold requiring urgent/emergent repair [1]
Observation Indications
- New or worsening symptoms in a patient with known TAA pending definitive imaging
- Borderline surgical-threshold aneurysm with concerning features
Discharge Criteria
- Asymptomatic, incidentally discovered TAA below surgical threshold
- Stable vital signs, adequate pain control, no malperfusion
- Established follow-up with cardiology or vascular/cardiothoracic surgery
Specialist Consultation Triggers
- Cardiothoracic/vascular surgery: Any symptomatic TAA, aneurysm approaching or exceeding surgical threshold, rapid growth, acute aortic syndrome [2][11]
- Genetics: Age <50, syndromic features, or family history of TAA/dissection [11]
- Cardiology: Aortic regurgitation, heart failure, surveillance coordination [2]
18. Follow Up / Return Precautions
Surveillance Imaging Schedule (per 2022 ACC/AHA) [2]
- TTE, CT, or MRI at diagnosis → repeat in 6–12 months to establish growth rate
- If stable: imaging every 6–24 months depending on diameter
- Post-TEVAR: CT at 1 month, 12 months, then annually [2]
- Post-open repair without residual aortopathy: CT/MRI within 1 year, then every 5 years [2]
- Post-open repair with residual aortopathy: annual imaging [2]
Return Precautions — Counsel Patients to Seek Immediate Care For:
- Sudden severe chest, back, or abdominal pain
- Difficulty breathing, new hoarseness, or difficulty swallowing
- Fainting, dizziness, or lightheadedness
- Weakness or numbness in an arm or leg
- Coughing up blood or vomiting blood
- Cold, pale, or painful extremity
Patient Counseling Points
- Emphasize lifelong BP control and medication adherence
- Strict smoking cessation
- Avoid heavy lifting, competitive sports, and stimulant drugs
- Genetic counseling and first-degree relative screening when indicated [6][11]
- Expected course: Most TAAs grow slowly (~1–2 mm/year), but growth accelerates with increasing size [11]
The following figure from the Yale Aortic Center illustrates outcomes of patients managed according to evidence-based surgical intervention criteria, validating the safety of conservative management below size thresholds and the importance of timely surgery once criteria are met:
References
1. ACR Appropriateness Criteria® Thoracic Aortic Aneurysm or Dissection-Treatment Planning and Follow-Up: 2024 Update. — Ripley B, Scheidt MJ, Aghayev A, et al. Journal of the American College of Radiology : JACR. 2025.
2. ACR Appropriateness Criteria® Thoracic Aortic Aneurysm or Dissection-Treatment Planning and Follow-Up: 2024 Update. — Ripley B, Scheidt MJ, Aghayev A, et al. Journal of the American College of Radiology : JACR. 2025.
3. ACR Appropriateness Criteria® Thoracic Aortic Aneurysm or Dissection-Treatment Planning and Follow-Up: 2024 Update. — Ripley B, Scheidt MJ, Aghayev A, et al. Journal of the American College of Radiology : JACR. 2025.
4. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. — Isselbacher EM, Preventza O, Hamilton Black Iii J, et al. Journal of the American College of Cardiology. 2022.
5. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. — Isselbacher EM, Preventza O, Hamilton Black Iii J, et al. Journal of the American College of Cardiology. 2022.
6. Thoracic Aortic Aneurysm and Dissection: Similarities, Differences and Pharmacotherapy. — Hu YN, Wang M, Zhang Z. Biochimica Et Biophysica Acta. Molecular Basis of Disease. 2026.
7. Thoracic Aortic Aneurysm and Dissection: Similarities, Differences and Pharmacotherapy. — Hu YN, Wang M, Zhang Z. Biochimica Et Biophysica Acta. Molecular Basis of Disease. 2026.
8. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. — Gulati M, Levy PD, Mukherjee D, et al. Journal of the American College of Cardiology. 2021.
9. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. — Gulati M, Levy PD, Mukherjee D, et al. Journal of the American College of Cardiology. 2021.
10. The Society for Vascular Surgery’s Multidisciplinary Management Guide on the Perioperative Care of Patients with Vascular Disease. — Rabih Chaer MD MS, Cassius Iyad Ochoa Chaar MD MS, Theodore Yuo MD, et al Society for Vascular Surgery (2023). 2023.
11. The Society for Vascular Surgery’s Multidisciplinary Management Guide on the Perioperative Care of Patients with Vascular Disease. — Rabih Chaer MD MS, Cassius Iyad Ochoa Chaar MD MS, Theodore Yuo MD, et al Society for Vascular Surgery (2023). 2023.
12. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. — Hiratzka LF, Bakris GL, Beckman JA, et al. Journal of the American College of Cardiology. 2010.
13. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. — Hiratzka LF, Bakris GL, Beckman JA, et al. Journal of the American College of Cardiology. 2010.
14. Thoracic Aortic Aneurysm. — Berger T, Dumfarth J, Kreibich M, et al. Nature Reviews. Disease Primers. 2025.
15. Thoracic Aortic Aneurysm. — Berger T, Dumfarth J, Kreibich M, et al. Nature Reviews. Disease Primers. 2025.
16. Acute Aortic Syndrome Revisited: JACC State-of-the-Art Review. — Vilacosta I, San Román JA, di Bartolomeo R, et al. Journal of the American College of Cardiology. 2021.
17. Acute Aortic Syndrome Revisited: JACC State-of-the-Art Review. — Vilacosta I, San Román JA, di Bartolomeo R, et al. Journal of the American College of Cardiology. 2021.
18. Acute Aortic Dissection and Intramural Hematoma: A Systematic Review. — Mussa FF, Horton JD, Moridzadeh R, et al. The Journal of the American Medical Association. 2016.
19. Acute Aortic Dissection and Intramural Hematoma: A Systematic Review. — Mussa FF, Horton JD, Moridzadeh R, et al. The Journal of the American Medical Association. 2016.
20. Thoracic Aortic Aneurysm and Dissection. — Goldfinger JZ, Halperin JL, Marin ML, et al. Journal of the American College of Cardiology. 2014.
21. Thoracic Aortic Aneurysm and Dissection. — Goldfinger JZ, Halperin JL, Marin ML, et al. Journal of the American College of Cardiology. 2014.
22. Thoracoabdominal Aortic Disease And Repair: JACC Focus Seminar, Part 3. — Ouzounian M, Tadros RO, Svensson LG, et al. Journal of the American College of Cardiology. 2022.
23. Thoracoabdominal Aortic Disease And Repair: JACC Focus Seminar, Part 3. — Ouzounian M, Tadros RO, Svensson LG, et al. Journal of the American College of Cardiology. 2022.
24. Society for Vascular Surgery Clinical Practice Guidelines of Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysms. — Upchurch GR, Escobar GA, Azizzadeh A, et al. Journal of Vascular Surgery. 2021.
25. Society for Vascular Surgery Clinical Practice Guidelines of Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysms. — Upchurch GR, Escobar GA, Azizzadeh A, et al. Journal of Vascular Surgery. 2021.
26. Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging: Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. — Goldstein SA, Evangelista A, Abbara S, et al. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 2015.
27. Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging: Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. — Goldstein SA, Evangelista A, Abbara S, et al. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 2015.
28. Impact of Nondiameter Aortic Indices on Surgical Eligibility: Results From the Treatment in Thoracic Aortic Aneurysm: Surgery Versus Surveillance (TITAN: SvS) Randomized Controlled Trial. — Dagher O, Appoo JJ, Herget E, et al. The Journal of Thoracic and Cardiovascular Surgery. 2025.
29. Impact of Nondiameter Aortic Indices on Surgical Eligibility: Results From the Treatment in Thoracic Aortic Aneurysm: Surgery Versus Surveillance (TITAN: SvS) Randomized Controlled Trial. — Dagher O, Appoo JJ, Herget E, et al. The Journal of Thoracic and Cardiovascular Surgery. 2025.
30. Association of Thoracic Aortic Aneurysm Size With Long-term Patient Outcomes: The KP-TAA Study. — Solomon MD, Leong T, Sung SH, et al. JAMA Cardiology. 2022.
31. Association of Thoracic Aortic Aneurysm Size With Long-term Patient Outcomes: The KP-TAA Study. — Solomon MD, Leong T, Sung SH, et al. JAMA Cardiology. 2022.
32. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. — Hiratzka LF, Bakris GL, Beckman JA, et al. Circulation. 2010.
33. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. — Hiratzka LF, Bakris GL, Beckman JA, et al. Circulation. 2010.
34. Multimodality Imaging of Thoracic Aortic Diseases in Adults. — Bhave NM, Nienaber CA, Clough RE, Eagle KA. JACC. Cardiovascular Imaging. 2018.
35. Multimodality Imaging of Thoracic Aortic Diseases in Adults. — Bhave NM, Nienaber CA, Clough RE, Eagle KA. JACC. Cardiovascular Imaging. 2018.
36. Endovascular Stent Grafting and Open Surgical Replacement for Chronic Thoracic Aortic Aneurysms: A Systematic Review and Prospective Cohort Study. — Sharples L, Sastry P, Freeman C, et al. Health Technology Assessment. 2022.
37. Endovascular Stent Grafting and Open Surgical Replacement for Chronic Thoracic Aortic Aneurysms: A Systematic Review and Prospective Cohort Study. — Sharples L, Sastry P, Freeman C, et al. Health Technology Assessment. 2022.
38. Thoracic Aortic Aneurysm Clinically Pertinent Controversies and Uncertainties. — Elefteriades JA, Farkas EA. Journal of the American College of Cardiology. 2010.
39. Thoracic Aortic Aneurysm Clinically Pertinent Controversies and Uncertainties. — Elefteriades JA, Farkas EA. Journal of the American College of Cardiology. 2010.