ESC Issues 2014 Guidelines on Aortic Disease

September 1, 2014—At the European Society of Cardiology’s ESC Congress 2014 in Barcelona, Spain, the society announced the publication of the 2014 ESC guidelines on the diagnosis and treatment of aortic diseases, which covers acute and chronic aortic diseases of the thoracic and abdominal aorta in adult patients. The guidelines were drafted by the ESC Task Force for the Diagnosis and Treatment of Aortic Diseases led by Chairperson Raimund Erbel, MD, and Chairperson Victor Aboyans, MD.

The guidelines are available online ahead of print in the European Heart Journal. Also online, additional supporting citations and images are provided in a Web Addenda.

The ESC session was dedicated to the new 2014 ESC Guidelines for aortic disease, covering genetic, screening, diagnostic, management, and follow-up of adult patients with thoracic or abdominal aortic disease. Dr. Erbel introduced the ESC session and discussed general aspects of the guidelines. Marco Roffi, MD, reviewed acute aortic syndromes; Bernard Iung, MD, reviewed thoracic aortic aneurysm and genetic aortic diseases; and Regula Sibylle Von Allmen, MD, discussed abdominal aortic aneurysm. Dr. Aboyans discussed long-term follow-up and provided closing remarks to the session.

In the ESC announcement of the Congress session, Prof. Michal Tendera, MD, and Prof. Petros Nihoyannopoulos, MD, briefly reviewed the guidelines.

According to Prof. Tendera and Nihoyannaopoulos, the 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases is the first European document to address comprehensively the acute and chronic diseases of the thoracic and abdominal aorta in adult patients. It fills the gap between multiple ESC Guidelines on different heart conditions and on peripheral arterial diseases published in 2011.

The professors noted aortic diseases, both acute and chronic, are within the scope of interest of cardiologists, but also radiologists, cardiac and vascular surgeons, acute care specialists, and others. They stated, “This makes the multidisciplinary approach obligatory and also indicates that this latest guideline should have an impact on medical practice well beyond cardiology. It is, therefore, impossible to overemphasize the role of these new ESC guidelines on the diagnosis and treatment of aortic diseases.”

In an overview ofthe guidelines, Prof. Tendera and Nihoyannaopoulos stressed the following:

• Aortic diseases are frequently asymptomatic, but acute aortic syndromes are among the most dramatic clinical conditions. Differential diagnosis between acute coronary syndromes and aortic dissection is often challenging. Precise diagnosis is of utmost importance, since treatment strategies are quite different.
• Imaging techniques (including ultrasound, computed tomography, and magnetic resonance) are of utmost importance in making the diagnosis. Although the role of endovascular therapies is increasing, surgical treatment is often necessary. In many cases, a hybrid approach may be needed.
• Prognosis in patients with acute aortic syndromes steadily improves, and there is an increasing need for structured follow-up. Because the clinical course may be insidious, screening programs are being developed in specific populations.
• The spectrum of the aortic diseases is quite wide and most importantly includes aortic dissections, intramural hematomas, penetrating ulcers, thoracic and abdominal aneurysms, traumatic injuries, and lesions associated with bicuspid aortic valve. All these aspects are addressed in the current document.
• Special attention is given to genetic and congenital aortic diseases because preventive measures may decrease the likelihood of clinical events. Emphasis is also put on the aortic diseases in the elderly population, in which atherosclerotic or thromboembolic complications are likely to occur. Porcelain or coral reef aorta can cause major problems in patients scheduled for cardiac surgery. Inflammatory diseases and aortic tumors are also discussed in the document.