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Thoracic aortic aneurysm — master index¶
Last curated: 2026-10-28 · 20 wiki pages (11 curated, 9 draft pending audit) · 386-PMID master bibliography (+1 DOI-cited preprint) · 16 landmark-paper notes · 32-guideline registry · 54 cited NCT registrations + 1 ISRCTN · 41 open research questions
The condition in five sentences. Thoracic aortic aneurysm is a usually silent dilatation of the aortic root, ascending aorta, arch, or descending thoracic aorta whose principal danger is catastrophic dissection or rupture. Ascending disease is largely a non-atherosclerotic, genetically influenced degeneration of the aortic media; descending disease behaves more like atherosclerotic aortic disease. Management is anchored to a single crude variable — maximal diameter — with prophylactic surgery around 5.5 cm (lower for genetic aortopathies), even though most dissections occur below that threshold. Medical therapy has proven benefit only as surrogate growth-slowing in Marfan syndrome; no drug is proven for the degenerative majority. The field's frontier is individualized risk prediction beyond diameter, and its first-ever randomized threshold trial reads out ~2035.
Start here: overview.md → then follow a path below. The frontier lives in OPEN-QUESTIONS.md. Growth history lives in LOG.md.
Reading paths¶
- Clinical path — overview → imaging & surveillance → risk stratification → guidelines → medical therapy → surgery → dissection
- Science path — pathophysiology → genetics → hemodynamics & biomechanics → animal models → omics & emerging science
- "What's unknown" path — OPEN-QUESTIONS.md (start with its Dots not yet connected table — the cross-domain junctions no study has joined) → clinical trials landscape → biomarkers → the Open-questions section at the bottom of any page
- Human path — patient experience & advocacy → epidemiology & natural history → statistics sheet
Wiki pages¶
| Section | Page | One-line scope | Status |
|---|---|---|---|
| Foundations | overview.md | The disease, its stakes, and a map of this wiki | curated |
| Foundations | anatomy-and-classification.md | Segments, Crawford extents, definitions, measurement conventions | curated |
| Foundations | epidemiology-and-natural-history.md | Incidence, growth rates, hinge points, size paradox, outcomes | draft |
| Foundations | aortic-dissection.md | Type A/B, acute aortic syndromes, IRAD, post-dissection aorta | curated |
| Genetics | genetics-of-taa.md | Heritability, gene table, gene-validity curation, testing strategy | draft |
| Genetics | syndromic-aortopathies.md | Marfan, Loeys-Dietz, vascular EDS, Turner | curated |
| Genetics | bicuspid-aortopathy.md | The most common aortopathy; hemodynamic-vs-genetic debate | curated |
| Mechanism | pathophysiology.md | Medial degeneration, ECM, SMC switching, the TGF-β paradox | curated |
| Mechanism | hemodynamics-and-biomechanics.md | Wall stress vs strength, 4D-flow WSS, rupture-risk modeling | curated |
| Mechanism | animal-models.md | Mouse model table, what translates and what doesn't | curated |
| Clinical | imaging-and-surveillance.md | Modalities, measurement error, surveillance intervals, screening | draft |
| Clinical | risk-stratification-and-size-thresholds.md | Hinge points, indexed sizes, sex differences, beyond-diameter | curated |
| Clinical | medical-therapy.md | Trial-by-trial drug evidence; the losartan saga; drug cautions | draft |
| Clinical | surgical-and-endovascular-repair.md | Root/arch/descending techniques, outcomes, TEVAR, PEARS | draft |
| Clinical | guidelines.md | 2022 ACC/AHA thresholds with COR/LOE; how guidelines evolved | draft |
| Frontier | biomarkers.md | D-dimer, candidate markers, why none is in guidelines | curated |
| Frontier | omics-and-emerging-science.md | GWAS, PRS, single-cell atlases, ML on imaging, gene-therapy horizon | draft |
| Frontier | clinical-trials-landscape.md | Live NCT-verified trial map; TITAN:SvS; why trials are hard here | draft |
| Human | red-flags-and-safety-concerns.md | Emergency recognition, misdiagnosis data, screening triggers, activity/drug/pregnancy cautions | curated |
| Human | patient-experience-and-advocacy.md | Lived experience, organizations worldwide, awareness campaigns | draft |
Literature layer¶
| Artifact | What it holds |
|---|---|
| BIBLIOGRAPHY.md | Master bibliography: 386 unique PMIDs plus one DOI-cited preprint, live-verified, tagged, cited-by-indexed |
| notes/ | 16 structured deep notes on landmark papers (Coady 1997, IRAD 2000, losartan mouse 2006, 2022 guideline, aorta GWAS 2022...) |
| guidelines/REGISTRY.md | 32 clinical guidelines, standards and pathways worldwide with supersession chains, disagreements, watch list |
| statistics/STATISTICS.md | Sourced figures: incidence, dissection outcomes, surgical volumes, burden; 9 documented statistical conflicts |
| patient-voice/ | Patient organizations directory, experience themes, annotated sources |
Curation state¶
The 2026-10-28 sweep screened 182 unique PubMed records (window since 2026-10-14), added eight bibliography entries, catalogued an AHA aortic-surgery scientific statement, extracted TAA-specific statin-growth estimates from a new SRMA full text, and recorded ARISE III moving from recruiting to active-not-recruiting. Genetics was demoted curated → draft. No landmark note. See LOG.md and the search manifest.
The 2026-10-21 sweep screened 87 PubMed records, added eight bibliography entries, updated root-measurement and early psychological-recovery synthesis, and refreshed all 54 cited NCT registrations. The 52 records with prior structured snapshots were unchanged. The registry remains at 31 documents; its aviation full-text follow-up is now recorded. Imaging was demoted to draft for independent audit. See LOG.md and the search manifest.
The 2026-10-14 sweep (PubMed, Europe PMC, Crossref, ClinicalTrials.gov, ISRCTN) added 11 PMIDs and one DOI-cited preprint, three EACTS consensus documents to the registry, and the UK EARNEST trial (ISRCTN30838068), which earlier ClinicalTrials.gov-only sweeps had missed. It edited the clinical-trials, surgery and medical-therapy pages; medical-therapy was demoted from curated to draft for audit. None of the 52 previously tracked NCT records changed. See LOG.md and the search manifest.
The 2026-09-30 sweep added 15 bibliography records (14 in the requested publication window plus one 2025 guideline correction), updated six wiki pages, and checked all 52 cited trial registrations. Those six pages are draft pending a separate audit; 14 wiki pages retain their prior curated status. See LOG.md and the source/search manifest. No new landmark note was warranted.
Historical August audit: All 19 pages are status: curated as of 2026-08-28: an independent audit pass re-verified every inline citation against live PubMed/ClinicalTrials.gov records — 263 unique PMIDs and 49 NCTs re-checked, ~600 claim-citation pairs examined, zero fabricated or wrong-paper citations found, ~15 substantive precision errors found and fixed, 13 of the original 15 [unverified] flags resolved with real sources (the rest converted to explicit evidence-gap statements or documented as extraction limitations — 2 such notes remain on guidelines.md). Audit details in LOG.md.