p.67 抽出テキスト

Thoracic aortic aneurysm patients are usually asymptomatic, diagnosed incidentally during unrelated imaging or screenings. Symptoms such as chest pain, aortic regurgitation, and compression-related issues may occur.890 Patients with aortic root involvement (as seen in HTAD) are more prone to suffer from AAE.891,892 Thoracic aortic aneurysm growth rate is variable, associated with aetiology, location, and baseline aortic diameter.893–895 Degenerative TAAs grow faster in women than men and are associated with a threefold higher risk of AAE.24,873,896 When the aorta reaches 57.5 mm in size, reported yearly rates of rupture, dissection, and death are 3.6%, 3.7%, and 10.8%, respectively.897–899 9.2.2.3 Descending thoracic aorta and thoracoabdominal aorta

aneurysms They can involve different parts of the DTA and may extend to the AA: TAAA. TAAAs are divided into five groups900 according to the modified TAAA classification scheme (Figure 22), which is crucial for risk stratification. By classifying aneurysm extent, surgeons can anticipate procedure complexity, select suitable techniques, and reduce risks during surgical planning. Most DTA aneurysms and TAAA are degenerative with calcification, although other causes include trauma, infection, inflammation, or genetic factors901,902 (Figure 21). Patients with HTAD rarely develop

Media degeneration Inflammation Genetic disorders Infection

Thoracic aortic aneurysm (TAA)

Aetiology

Screening

Diagnostic TTE

TTE or TOE plus CCT or CMR

Root and ascending aorta

Descending aorta

HTAD BAV Sporadic TAA

Atherosclerosis Aortitis (infectious or not) Trauma

Abdominal aortic aneurysm (AAA)

Aetiology

Screening

Diagnostic DUS

DUS or CEUS, CCT or CMR

Atherosclerosis

Coarctation

Atherosclerosis

Figure 21 Thoracic and abdominal aortic aneurysms: aetiology, screening and diagnostic methods. AAA, abdominal aortic aneurysm; BAV, bicuspid aortic valve; CCT, cardiovascular computed tomography; CEUS, contrast-enhanced Doppler ultrasound; CMR, cardiovascular magnetic resonance; DUS, Doppler ultrasound; HTAD, heritable thoracic aortic disease; TAA, thoracic aortic aneurysm; TOE, transoesophageal echocardiography; TTE, transthoracic echocardiography. Downloaded from academic.oup.com/eurheartj/article/45/36/3538/7738955 by guest on 07 October 2026