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Clinical Practice Guidelines Registry — Thoracic Aortic Aneurysm

Last curated: 2026-08-27

Purpose. This registry catalogs the clinical practice guidelines, consensus statements, and formal care pathways that govern (or historically governed) the diagnosis, surveillance, and treatment of thoracic aortic aneurysm (TAA) and related aortopathies worldwide. It records documents — who issued them, what they cover, what each uniquely contributes, and how they succeed one another. The synthesis of what the current guidelines actually recommend (thresholds, class/level of evidence) lives in the wiki page guidelines.md and is deliberately not duplicated here. Every PMID below was retrieved from PubMed during the 2026-08-27 curation session; web-only sources are cited with URL and access date.

How to read status. current = the newest document of its lineage and scope; superseded by → = replaced by a named successor (follow the chain to find the live document); current (aging) = still the newest of its lineage but old enough that its evidence base predates the current major guidelines; adjacent = not a TAA guideline per se, but contains binding recommendations that interact with TAA care (e.g., valve guidelines covering bicuspid aortopathy). A superseded document remains historically important — landmark thresholds and definitions often originate there.

1. Master table

# Society / body Year Region Scope Citation + PMID/URL Status
1 ACC/AHA (joint committee, multisociety) 2022 USA All aortic disease: TAA, AAA, acute aortic syndromes, genetics, imaging, surgery, surveillance Isselbacher et al., Circulation 2022;146:e334–e482. PMID 36322642 (JACC version PMID 36334952) current
2 EACTS/STS 2024 Europe + USA (surgical) Acute and chronic syndromes of the entire "aortic organ"; open + endovascular therapy Czerny, Grabenwöger et al., Eur J Cardiothorac Surg 2024;65(2):ezad426. PMID 38408364 (Ann Thorac Surg version PMID 38416090) current
3 ESC 2024 Europe Peripheral arterial AND aortic diseases merged into one document (PAAD) Mazzolai, Teixido-Tura et al., Eur Heart J 2024;45:3538–3700. PMID 39210722 current
4 ESVS 2026 Europe (vascular surgery) Descending thoracic + thoraco-abdominal aortic diseases (129 recommendations) Wanhainen, Gombert et al., Eur J Vasc Endovasc Surg 2026;71:172–270. PMID 41448425 current
5 JCS/JSCVS/JATS/JSVS 2020 (Engl. 2023) Japan Aortic aneurysm and aortic dissection, comprehensive Ogino et al., Circ J 2023;87:1410–1621. PMID 37661428 current
6 SVS 2021 USA (vascular surgery) TEVAR for descending thoracic aortic aneurysm Upchurch et al., J Vasc Surg 2021;73:55S–83S. PMID 32628988 current
7 SVS/STS 2020 USA Reporting standards + new classification for type B aortic dissection Lombardi et al., J Vasc Surg 2020;71:723–747. PMID 32001058 current
8 AATS 2018 USA (surgical) Bicuspid aortic valve–related aortopathy (dedicated document) Borger et al., J Thorac Cardiovasc Surg 2018;156:e41–e74. PMID 30011777 (exec summary PMID 30011756) current
9 International expert panel (Ghent) 2010 International Marfan syndrome diagnostic criteria (revised Ghent nosology) Loeys et al., J Med Genet 2010;47:476–485. PMID 20591885 current
10 Johns Hopkins–led expert group (Genet Med) 2026 International Loeys-Dietz syndrome care management primer (update of 2014) MacCarrick et al., Genet Med 2026;28:102577. PMID 41988792 current
11 International consensus (Am J Med Genet C) 2017 International Vascular Ehlers-Danlos syndrome: diagnosis, natural history, management Byers et al., Am J Med Genet C 2017;175:40–47. PMID 28306228 current (aging)
12 AHA 2018 USA/International Turner syndrome cardiovascular health (incl. aortic dissection risk) Silberbach et al., Circ Genom Precis Med 2018;11:e000048. PMID 30354301 current (aging)
13 AHA/ACC 2015 USA Competitive athletes with aortic disease incl. Marfan (Task Force 7) Braverman et al., Circulation 2015;132:e303–e309. PMID 26621648 (JACC version PMID 26542664) current (aging)
14 ESC 2020 Europe Sports cardiology and exercise in cardiovascular disease (incl. aortopathies) Pelliccia et al., Eur Heart J 2021;42:17–96. PMID 32860412 current
15 VASCERN HTAD working group (EU ERN) 2022 Europe (rare-disease network) Diagnostic work-up pathway for (suspected) heritable thoracic aortic disease Caruana et al., Eur J Med Genet 2023;66:104673. PMID 36460281 current
16 CCS 2014 Canada Thoracic aortic disease: thresholds, imaging, medical therapy, genetics Boodhwani et al., Can J Cardiol 2014;30:577–589. PMID 24882528 current (aging)
17 CCS/CSCS/CSVS 2016 Canada Open and endovascular surgery for thoracic aortic disease Appoo et al., Can J Cardiol 2016;32:703–713. PMID 27233892 current (aging)
18 EACTS/ESVS 2019 Europe Aortic arch pathologies: expert consensus (open + endovascular) Czerny, Schmidli et al., Eur J Vasc Endovasc Surg 2019;57:165–198. PMID 30318395 current consensus; arch content now also covered by #2
19 ACC/AHA 2020 USA Valvular heart disease (BAV aortopathy sections interact with TAA care) Otto et al., J Am Coll Cardiol 2021;77:e25–e197. PMID 33342586 adjacent, current
20 ACCF/AHA/AATS + 8 societies 2010 USA Thoracic aortic disease (first comprehensive US TAD guideline) Hiratzka et al., Circulation 2010;121:e266–e369. PMID 20233780 (JACC version PMID 20359588) superseded by → #1 (2022 ACC/AHA)
21 ESC 2014 Europe Aortic diseases (thoracic + abdominal, acute + chronic) Erbel et al., Eur Heart J 2014;35:2873–2926. PMID 25173340 (corrigendum PMID 26129948) superseded by → #3 (2024 ESC)
22 ESVS 2017 Europe (vascular surgery) Descending thoracic aorta diseases Riambau et al., Eur J Vasc Endovasc Surg 2017;53:4–52. PMID 28081802 superseded by → #4 (2026 ESVS)
23 ACC/AHA 2016 USA Statement of clarification: surgery for aortic dilatation in BAV (reconciled #20 vs 2014 VHD guideline) Hiratzka et al., Circulation 2016;133:680–686. PMID 26637530 superseded by → #1 (2022 ACC/AHA)
24 Johns Hopkins–led expert group (Genet Med) 2014 International Loeys-Dietz syndrome: primer for diagnosis and management MacCarrick et al., Genet Med 2014;16:576–587. PMID 24577266 superseded by → #10 (2026 primer)

Count: 19 current/adjacent, 5 superseded.

2. Per-guideline entries

2.1 — 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease

  • Full citation: Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 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. Circulation. 2022;146(24):e334–e482. PMID 36322642. Dual-published: J Am Coll Cardiol 2022;80(24):e223–e393 (PMID 36334952); republished J Thorac Cardiovasc Surg 2023;166(5):e182–e331 (PMID 37389507).
  • Scope: the entire aorta — diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance across asymptomatic, stable symptomatic, and acute presentations (per abstract).
  • Unique contribution: merges and replaces the previously separate AHA/ACC guidance on thoracic aortic disease, peripheral artery disease (aortic sections), and bicuspid aortic valve disease into a single aortic document; per the abstract, adds new emphasis on shared decision-making (including pregnancy), institutional interventional volume, and Multidisciplinary Aortic Team expertise. Writing committee includes a lay stakeholder representative.
  • Successor/predecessor: supersedes the 2010 ACCF/AHA thoracic aortic guideline (Hiratzka 2010, PMID 20233780) and the 2016 BAV clarification statement (Hiratzka 2016, PMID 26637530).

2.2 — 2024 EACTS/STS Guidelines on the aortic organ

  • Full citation: Czerny M, Grabenwöger M, Berger T, et al. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg. 2024;65(2):ezad426. PMID 38408364. Dual-published: Ann Thorac Surg 2024;118(1):5–115 (PMID 38416090). Companion clinical-cases article: Czerny et al., Eur J Cardiothorac Surg 2024;66(3):ezae294 (PMID 39196761).
  • Scope: acute and chronic disease of the whole aorta from a surgical (cardiothoracic + cardiac) perspective, jointly issued by the leading European and US surgical societies.
  • Unique contribution: the explicit "aorta as an organ" framing — the fetched text states the shift "that recognizes the 'aorta as an organ' in its own right is a recent development" and recommends that diagnosis, treatment, and surveillance be approached from that perspective. Adopts Ishimaru zones (0–11) as the reporting standard and introduces the TEM (Type, Entry, Malperfusion) classification of dissection, formally recognizing "non-A non-B" dissection — a departure from pure Stanford dichotomy. Defines aneurysm of the root/ascending aorta as >45 mm (dilatation 40–45 mm) in its definitions section (fetched full text, accessed 2026-08-27, academic.oup.com/ejcts/article/65/2/ezad426/7614462). Recommends multidisciplinary aortic teams.
  • Successor/predecessor: first joint EACTS/STS comprehensive aortic guideline; on the EACTS side it functionally succeeds narrower consensus documents such as the 2019 EACTS/ESVS arch consensus (PMID 30318395), whose arch territory it now also covers.

2.3 — 2024 ESC Guidelines for peripheral arterial and aortic diseases (PAAD)

  • Full citation: Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024;45(36):3538–3700. PMID 39210722.
  • Scope: all peripheral arterial disease plus the whole aorta (acute aortic syndromes, aneurysm, genetic aortic diseases, imaging, surveillance, exercise) from the cardiology perspective.
  • Unique contribution: first ESC document to merge peripheral arterial and aortic disease; the fetched introduction states the guidelines are "updating and merging the 2017 peripheral arterial diseases and 2014 aortic diseases guidelines" (accessed 2026-08-27, academic.oup.com/eurheartj/article/45/36/3538/7738955). Emphasizes management in "expert and high-volume PAAD centres" with multidisciplinary teams; contains a dedicated genetic-testing/aortic-screening recommendation table and an algorithm for combined genetic + imaging screening in thoracic aortic disease (per fetched table of contents).
  • Successor/predecessor: supersedes the 2014 ESC aortic diseases guideline (Erbel 2014, PMID 25173340). Keywords list exercise and genetic aortic diseases among covered topics.
  • Note on the European landscape: with #2.2 and #2.4, Europe now has three concurrent current guideline systems (cardiology ESC, surgical EACTS/STS, vascular-surgical ESVS) with overlapping aortic scope, versus a single unified US document.

2.4 — 2026 ESVS Clinical Practice Guidelines on descending thoracic and thoraco-abdominal aortic diseases

  • Full citation: Wanhainen A, Gombert A, Antoniou GA, et al. European Society for Vascular Surgery (ESVS) 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases. Eur J Vasc Endovasc Surg. 2026;71(2):172–270. PMID 41448425.
  • Scope: per the abstract — 129 recommendations across acute thoracic aortic syndrome, chronic type B dissection, descending thoracic and thoraco-abdominal aneurysm, ruptured DTA/TAAA, blunt thoracic aortic injury; plus genetic aortopathy, aortitis, mycotic aneurysm, coarctation, aberrant subclavian artery, service standards (surgical volume, imaging, risk assessment), and special situations (pregnancy, LSA revascularization, spinal cord ischaemia, stroke prevention, patient perspective).
  • Unique contribution: the most granular current guidance for the descending thoracic/thoraco-abdominal territory; explicitly issued "in succession to the 2017 version" (abstract); ends with a chapter on unresolved issues — direct raw material for open research questions.
  • Successor/predecessor: supersedes ESVS 2017 (Riambau, PMID 28081802).

2.5 — JCS/JSCVS/JATS/JSVS 2020 Guideline on aortic aneurysm and aortic dissection (Japan)

  • Full citation: Ogino H, Iida O, Akutsu K, et al. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J. 2023;87(10):1410–1621. PMID 37661428. (English version of the 2020 Japanese guideline.)
  • Scope: comprehensive — aneurysm and dissection, all segments, issued jointly by the Japanese Circulation Society and the Japanese cardiovascular/thoracic/vascular surgical societies.
  • Unique contribution: the major Asian-region comprehensive aortic guideline retrieved in this session; the writing panel includes medical genetics representation (Morisaki), and at >200 printed pages it is among the longest guideline documents in the field. Provides the reference standard for Japanese surgical-volume and practice context.
  • Successor/predecessor: English publication 2023 of the JCS 2020 revision; earlier JCS aortic guidance was Japanese-language only (not retrieved this session).

2.6 — SVS 2021 clinical practice guidelines on TEVAR for descending TAA

  • Full citation: Upchurch GR Jr, Escobar GA, Azizzadeh A, et al. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021;73(1S):55S–83S. PMID 32628988.
  • Scope: TEVAR for descending TAA and rarer DTA pathologies (dissection and trauma handled in separate SVS documents).
  • Unique contribution: the technical/procedural US standard for TEVAR: per the abstract, Grade 1A recommendation of TEVAR over open repair for elective DTA aneurysm in anatomically eligible patients, fine-cut (≤0.25 mm) CTA planning of the entire aorta plus iliofemoral and head/neck vessels, routine 3D centerline reconstruction, and lifelong contrast-CT surveillance (1 and 12 months post-TEVAR, then yearly). The abstract states plainly that "there is a lack of high-quality evidence across all TAA diseases, highlighting the need for better comparative effectiveness research."
  • Successor/predecessor: updates SVS's 2008-era TEVAR guidance (not retrieved this session); complements SVS/STS TBAD reporting standards (#2.7).

2.7 — SVS/STS 2020 reporting standards for type B aortic dissection

  • Full citation: Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020;71(3):723–747. PMID 32001058.
  • Scope: nomenclature and reporting, not treatment thresholds.
  • Unique contribution: per the abstract — a new classification system incorporating the arch, formal definitions of dissection chronicity, of complicated vs uncomplicated disease with a new "high-risk" group, and of false-lumen status/aortic remodeling for follow-up. Relevant to TAA because post-dissection aneurysmal degeneration is a major TAA aetiology and trial endpoint definitions flow from these standards.
  • Successor/predecessor: none direct; sits alongside the EACTS/STS 2024 TEM classification (#2.2) as one of two competing modern dissection classification schemes.

2.8 — AATS 2018 consensus guidelines on bicuspid aortic valve–related aortopathy

  • Full citation: Borger MA, Fedak PWM, Stephens EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg. 2018;156(2):e41–e74. PMID 30011777. Executive summary: same journal, 473–480. PMID 30011756.
  • Scope: BAV aortopathy only — natural history, phenotypes, histology/molecular pathomechanisms, imaging, surgical indications, surveillance, research agenda (per abstract).
  • Unique contribution: per its abstract, previous statements "addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process" — this is the only dedicated BAV-aortopathy guideline. Notes BAV prevalence 1–2% and aortic dilation in ~40% of referral-center BAV patients.
  • Successor/predecessor: the BAV threshold controversy it addresses traces through the 2010 TAD guideline, the 2014/2020 VHD guidelines, and the 2016 clarification statement (#2.15); BAV recommendations were subsequently updated in the 2022 ACC/AHA guideline (per that guideline's abstract), but the AATS document remains the deepest single-disease treatment.

2.9 — Revised Ghent nosology for Marfan syndrome (2010)

  • Full citation: Loeys BL, Dietz HC, Braverman AC, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet. 2010;47(7):476–485. PMID 20591885.
  • Scope: diagnostic criteria (not management).
  • Unique contribution: per the abstract — makes aortic root aneurysm and ectopia lentis the two cardinal features (either plus family history, an FBN1 mutation, or sufficient systemic score establishes the diagnosis), introduces the systemic scoring system, gives FBN1 testing greater weight, and adds provisions for children and alternative diagnoses. Still the operative diagnostic standard 16 years on; nearly all TAA guidelines' Marfan-specific recommendations presuppose it.
  • Successor/predecessor: replaced the original 1996 Ghent nosology (not retrieved this session). A 2025 fifteen-year retrospective by the original authors ("what we have gained, what we have missed" — Loeys et al., J Med Genet 2025;62:739–740, PMID 41115715) signals active revision discussion; see watch list.

2.10 — Loeys-Dietz syndrome care management primer (2026 update; 2014 original)

  • Full citations: MacCarrick G, Afifi RO, Allen R, et al. Loeys-Dietz syndrome: 2026 updated care management primer. Genet Med. 2026;28(7):102577. PMID 41988792. — Original: MacCarrick G, Black JH 3rd, Bowdin S, et al. Loeys-Dietz syndrome: a primer for diagnosis and management. Genet Med. 2014;16(8):576–587. PMID 24577266.
  • Scope: multisystem management of LDS (aortic/arterial aneurysm plus craniofacial, skeletal, allergic/GI manifestations).
  • Unique contribution: the only syndrome-specific management guidance for the most aggressive common heritable aortopathy; the 2026 abstract frames LDS as a heterogeneous group caused by pathogenic variants in TGF-β pathway genes and provides "an updated overview of effective management practices since the first LDS primer in 2014," with an explicit precision-medicine orientation (keyword). Gene-specific (genotype-stratified) surveillance is the axis on which LDS guidance differs most from general TAA guidelines.
  • Successor/predecessor: 2026 primer supersedes the 2014 primer.

2.11 — Vascular Ehlers-Danlos syndrome consensus (2017)

  • Full citation: Byers PH, Belmont J, Black J, et al. Diagnosis, natural history, and management in vascular Ehlers-Danlos syndrome. Am J Med Genet C Semin Med Genet. 2017;175(1):40–47. PMID 28306228.
  • Scope: vEDS (COL3A1) — diagnosis, surveillance, emergency planning.
  • Unique contribution: per the abstract — requires molecular confirmation of a causative COL3A1 variant before applying the diagnosis; recommends lifestyle modification, a "vascular EDS passport" emergency care plan, centralized management at experienced centers, aggressive blood-pressure control, and annual whole-vascular-tree surveillance (Doppler US, low-radiation CTA, or MRA). vEDS is the aortopathy in which prophylactic surgical thresholds are least diameter-driven — tissue fragility dominates decision-making — making this document the counterpoint to diameter-centric TAA guidelines.
  • Successor/predecessor: none newer retrieved; new natural-history data are accumulating (e.g., VEDS Collaborative cross-sectional study of 557 patients reporting male-predominant aortopathy and higher male mortality — Elhance et al., J Vasc Surg 2026;84:229–238, PMID 41616879), which will pressure an update. See watch list.

2.12 — AHA scientific statement on cardiovascular health in Turner syndrome (2018)

  • Full citation: Silberbach M, Roos-Hesselink JW, Andersen NH, et al. Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association. Circ Genom Precis Med. 2018;11(10):e000048. PMID 30354301.
  • Scope: congenital and acquired cardiovascular disease in Turner syndrome, including BAV, coarctation, and aortic dissection risk.
  • Unique contribution: per the abstract — the presentations and management of cardiovascular disease in Turner syndrome "differ significantly from the general population"; the statement is the dedicated reference for Turner aortopathy (where small body size makes indexed aortic dimensions decisive) and explicitly frames its own recommendations as "only the beginning of a process," i.e., provisional.
  • Successor/predecessor: none newer retrieved this session.

2.13 — Sports/exercise eligibility documents (2015 AHA/ACC; 2020 ESC)

  • Full citations: Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome. Circulation. 2015;132(22):e303–e309. PMID 26621648 (JACC version PMID 26542664). — Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021;42(1):17–96. PMID 32860412.
  • Scope: competitive athletics and exercise prescription; the ESC document covers all cardiovascular disease with aortopathies as a listed topic (keyword), the AHA/ACC task force is aorta-specific.
  • Unique contribution: these are the only documents giving sport-by-sport participation guidance for TAA/aortopathy patients. The US statement (2015) predates all current major aortic guidelines; the ESC document (2020) predates the 2022/2024 wave.
  • Successor/predecessor: no newer aorta-specific athlete statement was found in this session's searches; see watch list.

2.14 — VASCERN HTAD patient pathway (2022)

  • Full citation: Caruana M, Baars MJ, Bashiardes E, et al. HTAD patient pathway: Strategy for diagnostic work-up of patients and families with (suspected) heritable thoracic aortic diseases (HTAD). A statement from the HTAD working group of VASCERN. Eur J Med Genet. 2023;66(1):104673. PMID 36460281.
  • Scope: who should be referred to an HTAD expert centre and how diagnostic work-up, genetic testing, and family screening should proceed across the EU reference network.
  • Unique contribution: per the abstract — concrete referral triggers: thoracic aortic dissection (<70 y if hypertensive; any age if non-hypertensive); TAA with Z-score >3.5 in adults (2.5–3.5 if non-hypertensive or hypertensive and <60 y; Z >3 in children); family history of HTAD ± pathogenic variant; unexplained ectopia lentis; systemic score >5 (adults) / >3 (children). Recommends gene panels restricted to genes with definitive/strong HTAD association, cascade genetic screening, and serial aortic imaging of relatives. This is the only pathway-format document in the registry (care organization rather than treatment thresholds) and represents the European rare-disease-network layer. VASCERN's HTAD working group page and the pathway PDF are hosted at vascern.eu (VASCERN — "Heritable Thoracic Aortic Diseases (HTAD-WG)", https://vascern.eu/expertise/rare-diseases-wgs/aorta-wg/, and pathway PDF https://vascern.eu/app/uploads/2023/01/HTAD-Patient-Pathway-29082019_final.pdf; URLs verified via web search listing on 2026-08-27 — the site refused direct automated retrieval (HTTP 403), so the PubMed-indexed statement above is the citable version).
  • Successor/predecessor: none; complements (does not compete with) ESC/ACC-AHA genetic-testing recommendations.

2.15 — Canadian position statements (2014 medical; 2016 surgical)

  • Full citations: Boodhwani M, Andelfinger G, Leipsic J, et al. Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. Can J Cardiol. 2014;30(6):577–589. PMID 24882528. — Appoo JJ, Bozinovski J, Chu MWA, et al. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease. Can J Cardiol. 2016;32(6):703–713. PMID 27233892.
  • Scope: 2014 — size thresholds for intervention, imaging modalities, medical/lifestyle management, and genetics (explicitly not acute aortic syndromes, which it defers to the 2010 US guideline; per abstract). 2016 — surgical/endovascular interventions: valve repair, arch perfusion strategies, hybrid arch reconstruction for acute type A dissection, endovascular arch/descending treatment, type B dissection (per abstract).
  • Unique contribution: GRADE-methodology national statements; the 2014 document is unusual in covering driving and lifestyle counselling (MeSH terms include automobile driving, diet, exercise). Both predate the 2022/2024 guideline generation.
  • Successor/predecessor: none newer retrieved; the pair remains Canada's current national guidance.

2.16 — EACTS/ESVS expert consensus on aortic arch pathologies (2019)

  • Full citation: Czerny M, Schmidli J, Adler S, et al. Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2019;57(2):165–198. PMID 30318395.
  • Scope: aortic arch aneurysm and dissection — open, hybrid, and endovascular options.
  • Unique contribution: first joint surgical–vascular consensus on the arch, the anatomically hardest TAA territory; bridged the guideline gap between ascending (cardiac surgery) and descending (vascular surgery) documents until the 2024 EACTS/STS whole-aorta guideline arrived.
  • Successor/predecessor: its territory is now also covered by EACTS/STS 2024 (#2.2); no formal supersession notice was retrieved, so it is listed as a still-citable consensus.

2.17 — Adjacent: 2020 ACC/AHA valvular heart disease guideline

  • Full citation: Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. J Am Coll Cardiol. 2021;77(4):e25–e197. PMID 33342586.
  • Why it is in a TAA registry: BAV disease sits jointly in valve and aorta guidelines (bicuspid aortic valve is an indexed keyword of this document). The predecessor 2014 VHD guideline's BAV-aorta thresholds openly conflicted with the 2010 thoracic aortic guideline — the conflict that forced the 2016 clarification statement (#2.18). Valve-guideline revisions therefore remain a standing source of potential discordance with aortic guidelines.

2.18 — Superseded landmarks (kept for lineage)

  • 2010 ACCF/AHA et al. thoracic aortic disease guideline. Hiratzka LF, Bakris GL, Beckman JA, et al. Circulation. 2010;121(13):e266–e369. PMID 20233780 (JACC: 2010;55:e27–e129, PMID 20359588). First comprehensive US guideline dedicated to thoracic aortic disease; ten co-issuing societies; origin of much of the surveillance architecture later carried into 2022. Superseded by the 2022 ACC/AHA guideline (whose abstract states that recommendations from previous AHA/ACC thoracic-aortic, PAD, and BAV guidance "have been updated").
  • 2014 ESC aortic diseases guideline. Erbel R, Aboyans V, Boileau C, et al. Eur Heart J. 2014;35(41):2873–2926. PMID 25173340; corrigendum Eur Heart J 2015;36:2779 (PMID 26129948). First ESC guideline treating the whole aorta ("the document covers acute and chronic aortic diseases of the thoracic and abdominal aorta"); superseded by the 2024 ESC PAAD guideline (verified: the 2024 introduction states it is "updating and merging" the 2017 PAD and 2014 aortic documents).
  • 2017 ESVS descending thoracic aorta guideline. Riambau V, Böckler D, Brunkwall J, et al. Eur J Vasc Endovasc Surg. 2017;53(1):4–52. PMID 28081802. The vascular-surgical standard for the DTA for nearly a decade; superseded by the ESVS 2026 guideline (verified: "in succession to the 2017 version").
  • 2016 ACC/AHA statement of clarification on BAV aortic surgery. Hiratzka LF, Creager MA, Isselbacher EM, et al. Circulation. 2016;133(7):680–686. PMID 26637530. Written because two live US guidelines (2010 thoracic aortic; 2014 valvular heart disease) "differ[ed] with regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves" (abstract); it replaced Section 9.2.2.1 of the 2010 TAD guideline and Section 5.1.3 of the 2014 VHD guideline. Superseded in turn by the 2022 ACC/AHA guideline. The clearest documented case of intra-body guideline discordance in this field.
  • 2014 Loeys-Dietz primer. MacCarrick G, Black JH 3rd, Bowdin S, et al. Genet Med. 2014;16(8):576–587. PMID 24577266. Superseded by the 2026 updated primer (PMID 41988792).

3. Disagreements and gaps between guidelines

Each point below is limited to what the retrieved abstracts/full-text excerpts support; deeper threshold-level comparison belongs to guidelines.md.

Documented disagreements

  1. BAV aortopathy thresholds have a documented history of formal conflict. The 2016 ACC/AHA clarification exists precisely because the 2010 thoracic aortic and 2014 valvular guidelines recommended different surgical thresholds for BAV-associated aortic dilatation (Hiratzka 2016, PMID 26637530). The AATS then judged existing guidance insufficient and issued the only dedicated BAV-aortopathy guideline (Borger 2018, PMID 30011777: prior documents "addressed" but "none focused entirely on" the disease). Whether the 2022 ACC/AHA, 2024 ESC, and 2024 EACTS/STS BAV recommendations are now mutually consistent is a live question for the synthesis page — the institutional fragmentation that produced the 2010/2014 conflict (valve vs aorta committees; cardiology vs surgery) persists.
  2. Dissection classification is currently bifurcated. SVS/STS 2020 built a new type-B-centred classification with arch involvement, chronicity, and a high-risk uncomplicated category (Lombardi 2020, PMID 32001058), while EACTS/STS 2024 promotes the TEM (Type, Entry, Malperfusion) scheme with formal "non-A non-B" dissection (fetched full text, PMID 38408364). Registries and trials citing different schemes will not be directly comparable; no harmonization document was found.
  3. Structural divergence between the US and Europe. The US consolidated everything into one document (2022 ACC/AHA); Europe now runs three concurrent current systems — ESC 2024 (cardiology, aorta merged with PAD), EACTS/STS 2024 (surgical, "aortic organ"), ESVS 2026 (vascular surgery, DTA/TAAA) — whose scopes verifiably overlap on descending thoracic aneurysm, TEVAR, and acute aortic syndromes (all three abstracts/excerpts cover them). Overlap of this kind is the structural precondition for recommendation-level conflict; mapping the actual conflicts is flagged as an open question.
  4. Definitional inconsistency risk: what counts as an "aneurysm." EACTS/STS 2024 defines root/ascending aneurysm as >45 mm and dilatation as 40–45 mm (fetched text), while the classic definition used elsewhere is ≥1.5× normal diameter (which EACTS/STS retains for descending/abdominal segments). Definitions drive epidemiology and referral; the registry found no cross-society statement reconciling them.
  5. Athlete/exercise guidance lags the current guideline generation. The aorta-specific US athlete statement dates to 2015 (Braverman, PMID 26621648) and the ESC sports guideline to 2020 (Pelliccia, PMID 32860412) — both predate the 2022/2024/2026 aortic guidelines they must be used alongside.

Gaps no retrieved guideline resolves

  1. Evidence quality is admitted to be weak at the base. SVS 2021 states there is "a lack of high-quality evidence across all TAA diseases" and calls for comparative-effectiveness research (Upchurch 2021, PMID 32628988); ESVS 2026 closes with a chapter of unresolved issues (Wanhainen 2026, PMID 41448425). Virtually all intervention thresholds rest on observational cohorts.
  2. No population-based TAA screening. Family/cascade screening is addressed (2022 ACC/AHA abstract, PMID 36322642; VASCERN pathway, PMID 36460281), but none of the 24 catalogued documents establishes population screening for TAA (in contrast to AAA screening programs) — silent gap; no guideline argues for or against it in the retrieved material.
  3. Genotype-stratified management exists only for a few syndromes. LDS (2026 primer) and vEDS (2017 consensus) have gene-aware documents; the VASCERN pathway defines which genes merit panel inclusion (definitive/strong HTAD association). No retrieved guideline provides validated gene-by-gene intervention thresholds across the broader nonsyndromic HTAD gene set (ACTA2, PRKG1, etc. are managed by extrapolation) — this is exactly the space the wiki's genetics and risk-stratification pages should track.
  4. Turner syndrome guidance is explicitly provisional. The 2018 AHA statement describes its own recommendations as "only the beginning of a process" pending quality indicators and outcome studies (Silberbach 2018, PMID 30354301).
  5. vEDS management rests on a 2017 consensus while natural-history data accumulate. Sex-stratified outcome differences (male-predominant aortopathy, higher male mortality) reported by the VEDS Collaborative (Elhance 2026, PMID 41616879) are not reflected in any current guideline.
  6. No dedicated national TAA guideline was identified in this session's searches for the UK (NICE) or other major jurisdictions beyond the US, Europe, Canada, and Japan documents above — clinicians elsewhere default to the US/European documents. (Negative finding; limited to what was searched on 2026-08-27.)

4. Watch list — what is likely to change next, and where to check

What Why it is likely to move Where to check
Ghent nosology revision (Marfan diagnostic criteria) The original authors published a 15-year retrospective in 2025 explicitly weighing "what we have gained, what we have missed" (Loeys 2025, PMID 41115715) J Med Genet; PubMed query Ghent nosology Marfan
vEDS management consensus update 2017 consensus (PMID 28306228) + new VEDS Collaborative natural-history data incl. sex differences (PMID 41616879) Am J Med Genet C; J Vasc Surg; PubMed query vascular Ehlers-Danlos management consensus
US athlete/sports eligibility statement for aortic disease Current version is 2015 (PMID 26621648), two guideline generations old AHA professional statements (professional.heart.org); Circulation
Canadian CCS position statements 2014/2016 pair (PMIDs: 24882528, 27233892) predates TEVAR-era and genetics-era updates ccs.ca; Can J Cardiol
ACC/AHA aortic guideline focused updates 2010→2022 was a 12-year full cycle; focused updates/errata typically appear mid-cycle (the 2022 document already has multiple co-publications) acc.org / professional.heart.org guideline hubs; Circulation/JACC
Turner syndrome cardiovascular statement 2018 statement self-describes as provisional (PMID 30354301) Circ Genom Precis Med; AHA statements
Harmonization between ESC 2024 / EACTS/STS 2024 / ESVS 2026 Three overlapping current European documents (see §3.3); joint or endorsement documents would be the fix escardio.org, eacts.org, esvs.org guideline pages
JCS/JSCVS aortic guideline revision JCS guidelines revise on rolling cycles; current English version is the 2020 revision (PMID 37661428) Circulation Journal; jcs.gr.jp
VASCERN HTAD outputs (pathways, Do's/Don'ts) ERN working groups issue incremental pathway documents vascern.eu (HTAD-WG page; direct automated access blocked, browse manually)

Registry maintained under CONVENTIONS.md §3. All PMIDs retrieved from PubMed on 2026-08-27; society-website URLs listed were verified by web search/fetch on the same date. Recommendations synthesis: see guidelines.md.