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thoracoabdominal aortic aneurysms without dissection. Mean age at diagnosis is 59–69, with a male predominance of 2–4:1. Aneurysm growth rate is 1.9–3.4 mm per year,902,903 but tends to increase notably with diameters over 50 mm or post-proximal aorta surgery in patients with MFS. In this population, debate continues as to whether this reflects a more vulnerable aorta associated to the genetic disease or haemodynamic changes post-surgery. For untreated DTA aneurysm patients, 5 year survival is about 54%, with aortic rupture as the leading cause of death.904 Rupture risk factors include HTAD, a diameter over 50 mm, hypertension, smoking, chronic obstructive pulmonary disease (COPD), symptoms, chronic aortic dissection, and age. A significant rise in AAE risk occurs at a 60 mm diameter. Although dissection can occur in smaller aortas, the individual risk is low.899 High-risk features for rupture are represented in Figure 23. High-risk features for TAAA rupture beyond aortic diameter Aortic root and ascending aorta Thoracoabdominal aorta Radiological signs of AAA rupture Retroperitoneal haematoma Contrast extravasation High crescent sign Paraortic fat stranding Tangential calcification Calcification discontinuity Thrombus fissuration Draped aorta sign Relation with patient’s height Upper normal limits of aortic diameter by age Uncontrolled resistant hypertension Saccular aneurysm associated to PAU Uncontrolled resistant hypertension COPD Aortic length measurement Yearly rate of diameter growth Root vs ascending phenotype Genetic predisposition Aortic growth rate: Ascending aorta and arch ≥ 3mm/year DTAA ≥ 10mm/year (or ≥ 5mm/6 months) AAA ≥ 10mm/year (or ≥ 5mm/6 months) Symptoms Descending thoracic aorta Figure 23 Risk factors for thoracic and abdominal aneurysm rupture. AAA, abdominal aortic aneurysm; COPD, chronic obstructive pulmonary disease; DTAA, descending thoracic aorta aneurysm; PAU, penetrating atherosclerotic ulcer; TAAA, thoracoabdominal aortic aneurysm.905–908 Downloaded from academic.oup.com/eurheartj/article/45/36/3538/7738955 by guest on 07 October 2026