TAA Statistics — Quick-Reference Sheet
Last curated: 2026-08-27
Purpose. This sheet is the numbers layer of the thoracic-aortic-aneurysm knowledge base: a dense, source-locked table of published statistics on TAA and acute aortic dissection (AAD) — incidence, prevalence, natural history, surgical activity and outcomes, burden of disease, and screening yields. It complements (and deliberately does not repeat the prose of) wiki/epidemiology-and-natural-history.md; where that page argues, this sheet tabulates. Conflicting estimates are shown side by side with population, period, and method — never averaged or silently reconciled. All PMIDs were retrieved from PubMed during the 2026-08-27 curation session; portal pages were fetched the same day.
How to cite from this sheet. Always carry the PMID (or portal URL + access date) forward with the figure — never cite "the statistics sheet" as the source. Inline format: (Author Year, [PMID 12345678](https://pubmed.ncbi.nlm.nih.gov/12345678/){target="_blank" rel="noopener"}); portals: (Publisher — "Title", URL, accessed 2026-08-27). If a figure below is marked derived, it was computed from the cited source's numbers and should be re-derived, not quoted as published.
1. TAA incidence and prevalence
1.1 Clinically detected incidence
| Figure |
Population |
Period |
Method |
Source |
| 5.9 /100,000 person-yrs (age/sex-adjusted); sexes equal |
Olmsted County, MN (72 cases) |
1951–1980 |
Population-based record linkage, pre-CT era; rupture occurred in 74% (53/72), and 37 of those 53 had no prior aneurysm diagnosis |
(Bickerstaff 1982, PMID 7147188) |
| 10.4 /100,000 person-yrs (95% CI 8.6–12.2) — >3× the prior-era rate |
Olmsted County, MN (133 cases, degenerative TAA) |
1980–1994 |
Population-based cohort; rise attributed to CT/echo/MRI diffusion |
(Clouse 1998, PMID 9851478) |
| 16.3 (men) and 9.1 (women) /100,000/yr by 2002; +52% in men, +28% in women over the period |
Sweden, nationwide (14,229 individuals with thoracic aortic disease) |
1987–2002 |
National healthcare registers (ICD-coded aneurysm + dissection); 78% diagnosed before death |
(Olsson 2006, PMID 17145990) |
| Pooled 5.3 /100,000/yr (95% CI 3.0–8.3); ruptured TAA 1.6 /100,000/yr (1.3–2.1) |
22 population-based studies, worldwide |
Inception–Oct 2020 |
Systematic review + random-effects meta-analysis |
(Gouveia e Melo 2022, PMID 33705940) |
| 9 /100,000 patient-yrs (95% CI 6.8–12.6) — severe endpoints only (ruptured or operated TAA); AD separately 15 /100,000 |
Malmö Diet and Cancer cohort, n=30,412, middle-aged |
~16 yrs median follow-up (to ~2010s) |
Prospective cohort; counts only rupture/surgery, so undercounts diagnoses |
(Landenhed 2015, PMID 25609416) |
1.2 Prevalence
| Figure |
Population |
Period |
Method |
Source |
| 0.16% (95% CI 0.12–0.20) pooled prevalence (all study designs, autopsy included) |
Population-based studies, worldwide |
to 2020 |
Meta-analysis |
(Gouveia e Melo 2022, PMID 33705940) |
| 0.76% (95% CI 0.47–1.13) in autopsy-only studies vs 0.07% (0.05–0.11) with autopsy studies excluded — a ~10-fold gap |
Same meta-analysis, stratified |
to 2020 |
Autopsy vs clinical ascertainment; quantifies the undiagnosed reservoir |
(Gouveia e Melo 2022, PMID 33705940) |
| 22% of thoracic aortic disease diagnosed only at death (78% before death) |
Sweden nationwide, 14,229 cases |
1987–2002 |
Register + death data |
(Olsson 2006, PMID 17145990) |
1.3 Age and sex distribution
| Figure |
Population |
Period |
Method |
Source |
| Median age 65 (men) vs 77 (women); incidence equal in both sexes |
Olmsted 1951–80 |
1951–1980 |
Population-based |
(Bickerstaff 1982, PMID 7147188) |
| 51% of TAAs in women; women older at recognition (mean 75.9 vs 62.8 yrs); 79% of ruptures in women |
Olmsted 1980–94 |
1980–1994 |
Population-based |
(Clouse 1998, PMID 9851478) |
| Male:female incidence 16.3 vs 9.1 /100,000/yr; operations rose 7-fold (men) and 15-fold (women) |
Sweden nationwide |
1987–2002 |
Registers |
(Olsson 2006, PMID 17145990) |
| Acute aortic syndrome incidence 10.2 (men) vs 5.7 (women) /100,000 person-yrs; mean age 71.8; incidence increases with age |
Olmsted County (133 AAS cases) |
1995–2015 |
Rochester Epidemiology Project record linkage |
(DeMartino 2018, PMID 30354376) |
2. Acute aortic dissection
2.1 Incidence (note the ascertainment gradient: registry-only < registry+death-certificate < prospective/autopsy-inclusive)
| Figure |
Population |
Period |
Method |
Source |
| Pooled AAD 4.8 /100,000/yr (95% CI 3.6–6.1); type A 3.0, type B 1.6; repaired 1.4; medically managed 3.4; in-hospital AAD death 1.3 /100,000/yr |
33 population-based studies |
to Aug 2020 |
Systematic review + meta-analysis; incidence "varied significantly between study designs and geographical regions" |
(Gouveia e Melo 2022, PMID 34560218) |
| 3.5 /100,000/yr (95% CI 2.4–4.6); TAA rupture also 3.5; AAA rupture ~9 |
Olmsted County (39 AAD) |
1980–1994 |
Population-based; 85% involved ascending aorta |
(Clouse 2004, PMID 14959911) |
| 6 /100,000/yr (95% CI 4–7) — prospective, includes pre-hospital deaths |
Oxfordshire, UK (OXVASC), pop. 92,728; 52 incident events (37 type A, 15 type B) |
2002–2012 |
Prospective population surveillance |
(Howard 2013, PMID 23599348) |
| 2.9 /100,000/yr |
Hungary, pop. 106,500 (84 patients incl. 18 pre-hospital deaths) |
27 yrs (to ~1990s) |
Longitudinal population study incl. autopsy records |
(Mészáros 2000, PMID 10807810) |
| 2.53 /100,000/yr (age/sex-adjusted), flat over 22 yrs |
Iceland, whole nation (153 ATAD) |
1992–2013 |
Hospital discharge + autopsy + cause-of-death registries |
(Melvinsdottir 2016, PMID 27334108) |
| 7.2 /100,000/yr (9.1 men, 5.4 women); decreasing in men over time |
Sweden, nationwide (8,057 patients; 29% dead without hospital stay) |
2002–2016 |
National Patient Register + Cause of Death Register |
(Smedberg 2020, PMID 32558879) |
| 4.2 /100,000 patient-yrs (validated cases); type A 2.2, type B 1.5 |
Denmark, nationwide (3,023 validated AD) |
1996–2016 |
Register cases individually validated against medical records |
(Obel 2022, PMID 36321467) |
| AD component of AAS: 4.4 /100,000 person-yrs; IMH 1.2; PAU 2.1 (PAU rising 0.6→2.6, p=0.008); overall AAS 7.7, stable |
Olmsted County |
1995–2015 |
Population-based, imaging/record/death-certificate review |
(DeMartino 2018, PMID 30354376) |
| 15 /100,000 patient-yrs |
Malmö cohort (middle-aged, n=30,412) |
~16 yrs follow-up |
Prospective cohort endpoints |
(Landenhed 2015, PMID 25609416) |
2.2 Type A vs type B proportions
| Figure |
Population |
Period |
Source |
| 62.3% type A (of 464) |
IRAD, 12 referral centers |
1996–1998 |
(Hagan 2000, PMID 10685714) |
| 2,952 type A : 1,476 type B (67%:33%) among 4,428 enrolled |
IRAD, 28 centers |
1995–2013 |
(Pape 2015, PMID 26205591) |
| 66.0% type A (101/153) |
Iceland, population-based |
1992–2013 |
(Melvinsdottir 2016, PMID 27334108) |
| 60.5% type A : 39.5% type B (validated) |
Denmark, nationwide |
1996–2016 |
(Obel 2022, PMID 36321467) |
| Type A 3.0 vs type B 1.6 /100,000/yr (pooled) |
33-study meta-analysis |
to 2020 |
(Gouveia e Melo 2022, PMID 34560218) |
| Proximal:distal 5.1:1 (autopsy-inclusive) |
Hungary, population-based |
27 yrs |
(Mészáros 2000, PMID 10807810) |
2.3 Untreated type A early mortality — what actually supports "1–2% per hour"
Claim provenance: the figures usually cited are Hirst 1958 — "Dissecting aneurysm of the aorta: a review of 505 cases" (Medicine 1958;37:217-79, PMID 13577293) — and the review by Anagnostopoulos 1972 (Am J Cardiol 1972;30:263-73, PMID 4557973). Both PMIDs verified to exist this session, but neither has an abstract on PubMed, so their internal figures could not be re-verified this session — treat any hour-by-hour number attributed to them as [unverified at source] until the full texts are pulled.
What population data retrievable this session actually show for essentially untreated cohorts:
| Figure |
Population |
Period |
Method |
Source |
| Of hospitalized patients: 22.7% dead ≤6 h, 33.3% ≤12 h, 50% ≤24 h, 68.2% ≤48 h; only 6/84 operated; all non-operated died; plus 21% dead before admission |
Hungary, population-based (84 pts) |
27-yr period |
Records + autopsy; authors explicitly frame the cohort as approximating the natural (untreated) course |
(Mészáros 2000, PMID 10807810) |
| Arithmetic on the row above (derived): ≈3.8%/h over first 6 h, ≈2%/h averaged over first 24 h — i.e., the classic "1–2%/h" is the right order of magnitude for the first day but front-loaded |
— |
— |
Derived from Mészáros figures; re-derive before quoting |
(from Mészáros 2000, PMID 10807810) |
| In-hospital mortality 58% for type A managed medically (not operated, typically due to age/comorbidity) vs 26% surgical |
IRAD (464 pts) |
1996–1998 |
Registry; medical-arm selection bias inflates the estimate as a "natural history" proxy |
(Hagan 2000, PMID 10685714) |
| 48.6% of incident type A died before hospital assessment |
OXVASC, UK |
2002–2012 |
Prospective population capture |
(Howard 2013, PMID 23599348) |
| 21.4% of arrivals dead within 24 h; 45.2% at 30 days (all ATAD, era of surgical treatment); >half of all patients dead within 30 days of the index event |
Iceland, whole nation |
1992–2013 |
Population registries incl. autopsy |
(Melvinsdottir 2016, PMID 27334108) |
Evidence-quality verdict: the per-hour claim rests on mid-20th-century case series; the best modern population-based corroboration (Mészáros) is compatible with ~1–4%/h over the first 24–48 h in unoperated patients, but no contemporary series can ethically reproduce it, and modern cohorts (with surgery) show much lower early mortality.
2.4 Pre-hospital death fraction (why hospital registries undercount)
| Figure |
Population |
Period |
Source |
| 48.6% of type A dead before hospital assessment (61.1% of these women) |
OXVASC, prospective |
2002–2012 |
(Howard 2013, PMID 23599348) |
| 29% of all AD diagnosed dead without a hospital stay (2,300/8,057) |
Sweden nationwide |
2002–2016 |
(Smedberg 2020, PMID 32558879) |
| 21% dead before admission |
Hungary population study |
27 yrs |
(Mészáros 2000, PMID 10807810) |
| 17.6% dead before hospital arrival |
Iceland whole-nation |
1992–2013 |
(Melvinsdottir 2016, PMID 27334108) |
2.5 In-hospital / 30-day mortality by type, management, and era
| Figure |
Population |
Period |
Method |
Source |
| Overall in-hospital 27.4%; type A surgical 26%, type A medical 58%; type B medical 10.7%, type B surgical 31.4% |
IRAD, 464 pts, 12 centers |
1996–1998 |
Referral-center registry (survivors of transport only) |
(Hagan 2000, PMID 10685714) |
| Type A in-hospital 31%→22% and surgical 25%→18% across 6 enrollment eras; type B 12%→14% (NS); surgery for type A 79%→90%; TEVAR for type B 7%→31%; CT first test 46%→73% |
IRAD, 4,428 pts, 28 centers |
1995–2013 |
Registry trend analysis |
(Pape 2015, PMID 26205591) |
| >7,300 cases, >51 sites, 12 countries; significant fall in type A in-hospital mortality over 20 yrs, none in type B |
IRAD 20-year synthesis |
1996–2016 |
Registry review |
(Evangelista 2018, PMID 29685932) |
| 30-day mortality: type A 22.0%, type B 13.9% — no significant change 1996–2016; 5-yr adjusted HR vs matched hypertensive controls 3.2 (A) and 2.1 (B) |
Denmark nationwide, validated cases |
1996–2016 |
Population registers (includes non-referral deaths) |
(Obel 2022, PMID 36321467) |
| 30-day case fatality 47.4% (type A reaching hospital), 13.3% (type B); 5-yr survival of 30-day survivors 85.7% / 83.3% |
OXVASC |
2002–2012 |
Prospective population-based |
(Howard 2013, PMID 23599348) |
| Hospitalized 30-day mortality 26%→21% (2002–06 vs 2012–16); surgical repair within 14 days 27%→35%; women 17% vs men 12% after acute repair |
Sweden nationwide |
2002–2016 |
Registers |
(Smedberg 2020, PMID 32558879) |
| Median survival 3 days (all AAD incl. unoperated); 5-yr survival 32% (vs 5% in 1951–80); operated 30-day case fatality 9% |
Olmsted County |
1980–1994 |
Population-based |
(Clouse 2004, PMID 14959911) |
| Women: 32.1% of AAD; higher in-hospital mortality (adjusted OR 1.4); type A surgical mortality 32% vs 22% in men |
IRAD, 1,078 pts |
1996– (pub. 2004) |
Registry |
(Nienaber 2004, PMID 15197151) |
2.6 Misdiagnosis and diagnostic delay
| Figure |
Population |
Period |
Source |
| 39% initially misdiagnosed (most often as acute coronary syndrome); time to correct diagnosis 51±12 vs 15±5 h; 100% of misdiagnosed received aspirin, 85% heparin, 12% fibrinolytics; antithrombotic exposure → major bleeding 38% vs 13% |
66 consecutive AAS, tertiary center, Toronto |
2000–2004 |
Chart review |
| Median ED-presentation-to-diagnosis 4.3 h (IQR 1.5–24); diagnosis-to-surgery 4.3 h (2.4–24); delays associated with female sex, atypical/absent pain, normal BP, non-tertiary presentation (transfer delay-time-ratio 3.34) |
IRAD, 894/751 pts |
1996–2007 |
Registry regression |
| Aortic dissection was the initial clinical impression in only 15% of cases (13/84) |
Hungary, population-based |
27 yrs |
(Mészáros 2000, PMID 10807810) |
3. Growth and natural-history numbers
3.1 Growth rates
| Figure |
Population |
Period |
Method |
Source |
| Mean 0.12 cm/yr; mean size at presentation 5.2 cm |
Yale, 230 pts, 714 imaging studies |
1985–1996 |
Serial imaging, computerized database |
(Coady 1997, PMID 9081092) |
| Mean 0.10 cm/yr (370 pts, 1,063 studies) |
Yale, expanded |
1985–1997 |
Serial imaging |
(Coady 1999, PMID 10391339) |
| Mean 0.10 cm/yr (721 pts, 3,115 studies) |
Yale |
9 yrs prospective |
Serial imaging |
(Davies 2002, PMID 11834007) |
| 0.10 cm/yr overall: ascending 0.07, descending 0.19 |
Yale synthesis, 1,600 pts, 3,000 imaging studies |
to 2002 |
Database synthesis |
(Elefteriades 2002, PMID 12440685) |
| Range 0.2–4.2 mm/yr across studies; ascending/arch 0.2–2.8, descending/TAAA 1.9–3.4 mm/yr; studies "generally low" quality, methods heterogeneous |
Systematic review, 11 studies, n=1,383 |
to Apr 2015 |
SIGN-graded systematic review |
(Oladokun 2016, PMID 26947541) |
| Familial TAA 0.21 cm/yr vs sporadic 0.16 vs Marfan 0.1 (p<0.01) |
Yale, 520 interviewed probands |
to 2006 |
Pedigree + serial imaging |
(Albornoz 2006, PMID 16996941) |
Consistent growth accelerators across studies: larger current size, distal location, Marfan syndrome, bicuspid aortic valve; chronic dissection and COPD implicated (Oladokun 2016, PMID 26947541).
3.2 Size-dependent risk (Yale program) and replications
| Figure |
Population |
Period |
Source |
| Median size at rupture/dissection 6.0 cm (ascending) / 7.2 cm (descending); >6.0 cm: +32.1 percentage-points complication probability (ascending); >7.0 cm: +43.0 (descending) |
Yale, 230 pts |
1985–1996 |
(Coady 1997, PMID 9081092) |
| ≥6.0 cm: +25.2 points (ascending); ≥7.0 cm: +37.3 (descending); median complication sizes 5.9/7.2 cm |
Yale, 370 pts |
1985–1997 |
(Coady 1999, PMID 10391339) |
| Yearly rates at >6 cm: rupture 3.7%/yr; rupture-or-dissection 6.9%/yr; death 11.8%/yr; any 15.6%/yr; odds of rupture ×27 above 6 cm; unoperated 5-yr survival 54% |
Yale, 721 pts (570 analyzable; 304 dissection-free) |
9 yrs |
(Davies 2002, PMID 11834007) |
| Hinge points 6.0 cm (ascending) / 7.0 cm (descending); cumulative rupture-or-dissection risk on reaching them 31% / 43%; yearly at ≥6 cm: rupture 3.6%, dissection 3.7%, death 10.8%, any 14.1% |
Yale synthesis, 1,600 pts |
to 2002 |
(Elefteriades 2002, PMID 12440685) |
| Aortic size index (cm/m²): <2.75 → ~4%/yr; 2.75–4.24 → ~8%/yr; >4.25 → ~20%/yr (rupture/dissection/death) |
Yale, 410 pts with BSA |
to 2005 |
(Davies 2006, PMID 16368358) |
| Aortic height index (cm/m): ≤2.43 / 2.44–3.17 / 3.21–4.06 / ≥4.1 → 4% / 7% / 12% / 18% average yearly complication risk; AHI model fit modestly superior to ASI |
Yale, 780 pts |
to 2017 |
(Zafar 2018, PMID 29395211) |
| Moderate dilatation (4.0–5.5 cm, nonsyndromic): dissection/rupture 0.1%/patient-yr; 5-yr risk 0.4% @45 mm, 1.1% @50 mm, 2.9% @55 mm (with elective repair per practice) |
Asan Medical Center echo database, 4,654 adults, 14,432 patient-yrs |
to ~2015 |
(Kim 2016, PMID 27609684) |
| Mean aortic diameter at type A dissection 5.3 cm; 59% dissect at <5.5 cm, 40% at <5.0 cm; hypertension (OR 2.17) predicts dissection at smaller size; Marfan dissect larger (OR 14.3) |
IRAD, 591 type A |
1996–2005 |
(Pape 2007, PMID 17709637) |
| Population denominator: mean ascending aorta 3.2±0.4 cm; 79.2% <3.5 cm, 0.22% ≥4.5 cm; relative risk of dissection 0.055 (<3.5), 2.5 (3.5–3.9), 4.9 (4.0–4.4), 346.8 (≥4.5); ≥4.5 vs <3.5 cm: ×6,305 |
MRI reference population n=3,573 + dissection distribution |
published 2015 |
(Paruchuri 2015, PMID 25997607) |
3.3 Untreated-vs-treated survival anchors
| Figure |
Population |
Period |
Source |
| Untreated historical 5-yr survival 13% (7% with dissection, 19% without); 74% rupture |
Olmsted, pre-CT era |
1951–1980 |
(Bickerstaff 1982, PMID 7147188) |
| 5-yr rupture risk by size at recognition: <4 cm 0%, 4–5.9 cm 16%, ≥6 cm 31%; cumulative rupture 20% at 5 yrs; 5-yr survival 56% (vs 19% prior era) |
Olmsted |
1980–1994 |
(Clouse 1998, PMID 9851478) |
| Acute mortality: 41% ruptured TAA, 39% AD, 34% ruptured AAA |
Malmö cohort endpoints |
~16-yr follow-up |
(Landenhed 2015, PMID 25609416) |
| Elective preemptive repair "restored life expectancy to normal" (vs 54% 5-yr unoperated survival) |
Yale |
9 yrs |
(Davies 2002, PMID 11834007) |
| AAS 5/10/20-yr mortality 39%/57%/91% vs 18%/41%/66% in matched controls (adjusted mortality HR 2.1); excess concentrated in first 90 days |
Olmsted AAS |
1995–2015 |
(DeMartino 2018, PMID 30354376) |
4. Surgical activity and outcomes
4.1 Operative volumes and trends
| Figure |
Population |
Period |
Method |
Source |
| 45,894 proximal aortic operations captured in 5.5 yrs: 12,702 root, 22,048 supracoronary ascending, 6,786 ascending+arch, 4,358 root+arch |
STS Adult Cardiac Surgery Database, North America |
2004–2009 |
Registry query |
(Williams 2012, PMID 22958956) |
| 2,455 thoracic aortic operations nationwide; operations rose 7-fold (men) / 15-fold (women) over 16 yrs |
Sweden |
1987–2002 |
National registers |
(Olsson 2006, PMID 17145990) |
| Thoracic aortic procedures per year doubled; total UK cardiac surgery 534,067 procedures, overall in-hospital mortality 4.0%→2.8% |
UK NACSA (all cardiac surgery) |
2002–2016 |
Mandatory national audit |
(Grant 2021, PMID 36003724) |
| AD admissions 6,980→8,875/yr; type A open repairs 1,143→2,130/yr; TEVAR admissions 96 (2005)→1,130 (2012); type B open repair and medical-management volumes flat |
US National Inpatient Sample (weighted) |
2003–2012 |
Administrative (ICD-9) |
(Zimmerman 2016, PMID 27183856) |
| 25,462 ATAAD repairs (STS) over 13 yrs; arch involved in 46% of repairs (range 38.6–52.6% across 9 US regions) |
STS ACSD |
2004–2016 |
Registry |
(Helder 2020, PMID 31400338) |
| TEVAR uptake for type B in IRAD: endovascular management 7%→31% |
IRAD |
1995–2013 |
Registry |
(Pape 2015, PMID 26205591) |
| Medicare descending TAA repairs: 12,573 open vs 2,732 TEVAR |
US Medicare |
1998–2007 |
Claims |
(Goodney 2011, PMID 22104552) |
4.2 Elective proximal (root/ascending/arch) repair mortality
| Figure |
Population |
Period |
Method |
Source |
| Elective operative mortality 3.4%; nonelective 15.4%; adjusted OR emergent-vs-elective 5.9 (95% CI 5.3–6.6) |
STS ACSD, 45,894 ops |
2004–2009 |
Registry risk model (c=0.81) |
(Williams 2012, PMID 22958956) |
| Ascending/arch 2.5%; descending/TAAA 8% (referral-center benchmark used in the hinge-point risk/benefit arithmetic) |
Yale |
to 2002 |
Single-center series |
(Elefteriades 2002, PMID 12440685) |
| Elective 9.0% vs emergency 21.7% (historical era) |
Yale, 136 operated of 230 |
1985–1996 |
Single-center |
(Coady 1997, PMID 9081092) |
| Elective arch repair: 30-day mortality 5.3%, permanent neurologic dysfunction 5.3% (791 consecutive; antegrade cerebral perfusion protective, OR 0.37) |
St. Antonius, Netherlands |
2005–2015 |
Single high-volume center |
(Cefarelli 2017, PMID 28760465) |
| Open descending/TAAA: elective 30-day 3.1% (DTA) and 9.9% (TAAA); nonelective 17.9%; paraplegia 0% (DTA) / 3.3% (TAAA) |
Liverpool, UK, 430 consecutive |
1998–2019 |
Single specialist center |
(Harky 2021, PMID 33068762) |
| 30-day mortality after operation 16% (all indications, incl. acute); 1/5/10-yr survival 92%/77%/57%; 10-yr reoperation 7.8% |
Sweden nationwide, 2,455 ops |
1987–2002 |
Registers |
(Olsson 2006, PMID 17145990) |
4.3 Acute type A repair mortality and era trend
| Figure |
Population |
Period |
Source |
| Surgical mortality 25%→18% across eras (in-hospital 31%→22%) |
IRAD |
1995–2013 |
(Pape 2015, PMID 26205591) |
| 30-day mortality 18.9% (ascending-only) vs 19.8% (+arch); earlier operative year independently predicted death |
STS ACSD, 25,462 repairs |
2004–2016 |
(Helder 2020, PMID 31400338) |
| Operative mortality 21.6% overall; national trend 23% (1998–2000)→19% (2005–2008) |
US NIS, 5,184 pts |
2003–2008 |
(Chikwe 2013, PMID 23562465) |
| In-hospital mortality 21.5% (low-volume) → 11.6% (high-volume tertile); overall trend down as volumes rose |
US NIS, 25,231 repairs |
2005–2014 |
(Dobaria 2020, PMID 32507629) |
| In-hospital mortality 15.3% (7,805 weighted repairs); age 71–80 OR 5.3, >80 OR 6.8 vs ≤40 |
US NIS |
2017–2018 |
(Catalano 2022, PMID 36172443) |
| GERAADA 30-day mortality 16.9% (2,137 pts); mortality-corrected permanent neurologic dysfunction 10.0%; circulatory arrest >30 min without cerebral perfusion: 31.4% mortality vs 21.4% with |
Germany, GERAADA |
4-yr accrual window |
(Krüger 2013, PMID 23657546) |
| GERAADA 30-day mortality 16.3% (women) vs 16.6% (men), 3,380 pts; women 37%, older (65.5 vs 59.2 yrs) |
Germany, 56 centers |
2006–2015 |
(Rylski 2021, PMID 31926709) |
| Marfan vs matched non-Marfan 30-day mortality 19.5% vs 20.1% (NS) |
GERAADA, 3,385 pts (117 Marfan) |
2006–2015 |
(Farag 2023, PMID 34446289) |
| UK: death and/or stroke 27.7% after TAAD repair (1,929 pts); DHCA-only vs unilateral ACP OR 5.35 for death/CVA |
UK NACSA |
2011–2018 |
(Benedetto 2021, PMID 33963362) |
4.4 Volume–outcome relationships
| Figure |
Population |
Period |
Source |
| AAD repair: surgeon <1 case/yr → 27.5% mortality vs ≥5/yr → 17.0% (OR 1.78); institution ≤3/yr → 27.4% vs >13/yr → 16.4% |
US NIS, 5,184 |
2003–2008 |
(Chikwe 2013, PMID 23562465) |
| ATAAD repair at low- vs high-volume hospitals: adjusted OR 2.10 for mortality; all complication classes higher at low volume |
US NIS, 25,231 |
2005–2014 |
(Dobaria 2020, PMID 32507629) |
| Elective root replacement (Medicare, 4,629 pts, 1,276 surgeons, 718 hospitals): nonlinear volume effect; high-volume hospitals (≥4.5 cases/yr) lower stroke (HR 0.51), MI (0.49), dialysis (0.44), reoperation (0.48); high-volume surgeons ≥9/yr similar pattern |
US Medicare |
2009–2014 |
(Brown 2021, PMID 33982345) |
| England: 6-month treatment rates for thoracic aortic disease varied 7.6–31.5% across counties; risk-adjusted 6-month mortality in untreated patients 19.4–36.3%; higher-volume regional units had significantly lower risk-adjusted mortality |
England HES (24,548) + NACSA (8,058) |
to 2015 |
(Bottle 2017, PMID 28292748) |
| 2022 ACC/AHA guideline adds "increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise" |
US guideline |
2022 |
(Isselbacher 2022, PMID 36334952) |
4.5 Open vs endovascular (descending TAA)
| Figure |
Population |
Period |
Source |
| Perioperative mortality intact TAA: TEVAR 6.1% vs open 7.1% (p=0.07); ruptured: 28% vs 46% (p<0.0001); but 5-yr survival worse in TEVAR-selected pts (62% vs 72%) — selection of sicker patients to TEVAR |
US Medicare, 15,305 repairs |
1998–2007 |
(Goodney 2011, PMID 22104552) |
| In-hospital mortality: type A open repair 20.5%→14.8%; type B open 18.0%→14.3%; TEVAR ~7.9% flat; medical 17.5%→13.9% |
US NIS (dissection admissions) |
2003–2012 |
(Zimmerman 2016, PMID 27183856) |
5. Global and national burden
Definition caveat (explicit): GBD models a single "aortic aneurysm" cause. The foundational GBD mortality paper analyzes "aortic dissection and aneurysms" merged into one AA cause (Sampson 2014, PMID 25432126), and the GBD 2019 burden analysis likewise reports one aortic-aneurysm cause with no thoracic/abdominal split (Wang 2022, PMID 35711350). No published TAA-specific share of GBD aortic-aneurysm deaths was found in this session's searches — treat any "TAA share of GBD deaths" claim as unsourced. (An IHME factsheet fetch was attempted and blocked, HTTP 403; healthdata.org, attempted 2026-08-27.)
| Figure |
Population |
Period |
Method |
Source |
| Global AA death rate 2.49 /100,000 (1990) → 2.78 (2010); highest regional rates Australasia (8.82→8.38) and Western Europe (7.69→7.68); men 3.40 vs women 2.15 (2010); death rates rising faster in developing regions (+0.71 vs +0.22 median relative change) |
GBD 2010, 21 world regions |
1990–2010 |
Cause-of-death ensemble modeling |
(Sampson 2014, PMID 25432126) |
| Absolute AA deaths +82.1% and DALYs +67% (1990→2019), but age-standardized death rate falling (EAPC −1.34, 95% CI −1.46 to −1.22) and DALY rate falling (EAPC −1.06); leading attributable risks: smoking, high systolic BP; burden concentrated in high-SDI regions, age-dependent, male-predominant |
GBD 2019, 204 countries |
1990–2019 |
GBD 2019 systematic analysis |
(Wang 2022, PMID 35711350) |
| US: 289,971 aortic aneurysm + dissection deaths, adults ≥25 (≈11,600/yr average — derived); age-adjusted mortality declining, AAPC −3.73% (95% CI −4.33 to −3.14); higher burden and slower decline in men and non-Hispanic Black adults; small rise in age 35–44 (AAPC +1.04%); Midwest and nonmetropolitan excess |
US, CDC WONDER |
1999–2023 |
Death-certificate database, joinpoint regression |
(Lv 2026, PMID 41776414) |
| US AA/AD mortality decline 1999–2020 disproportionately favors males and White decedents; male–female mortality gap widening 0.57 /100,000/yr |
US, CDC WONDER |
1999–2020 |
Death certificates, linear regression |
(Azuma 2025, PMID 39951651) |
| US: 21,221 AD-related deaths with hypertension as underlying cause; age-adjusted rate rose 1999–2006 (APC +3.87), fell sharply 2006–2009 (−18.95), rose again 2009–2019 (+3.52) |
US, CDC WONDER multiple-cause files |
1999–2019 |
Death certificates, joinpoint |
(Tabassum 2025, PMID 40365225) |
| In-hospital AAD death rate 1.3 /100,000 population/yr (pooled); geography a significant source of heterogeneity |
33 population studies |
to 2020 |
Meta-analysis |
(Gouveia e Melo 2022, PMID 34560218) |
| National case-mortality anchors for cross-checking coded death data: Denmark 30-day 22.0% (A) / 13.9% (B), stable 1996–2016; Sweden hospitalized 30-day 26%→21% (2002–2016) |
Denmark; Sweden |
1996–2016; 2002–2016 |
Validated national registers |
(Obel 2022, PMID 36321467; Smedberg 2020, PMID 32558879) |
6. Screening and family statistics
| Figure |
Population |
Period |
Method |
Source |
| 21% of TAA probands have a first-degree family member with arterial aneurysm |
Yale pedigrees |
to 2002 |
Family-history analysis |
(Elefteriades 2002, PMID 12440685) |
| 21.5% of non-Marfan TAA patients show a familial pattern; inheritance autosomal dominant in 76.9% (variable penetrance); familial probands younger than sporadic (58.2 vs 65.7 yrs; Marfan 27.4); among affected relatives 66.5% TAA, 24.9% AAA, 8.6% cerebral/other |
Yale, 520 interviewed TAA patients (88 familial pedigrees) |
to 2006 |
Structured pedigree study |
(Albornoz 2006, PMID 16996941) |
| Screening relatives of nonsyndromic TAD probands finds newly affected individuals in 33% of first-, 24% of second-, 15% of third-degree relatives; a specific gene mutation found in 25% of screened families; no studies of screening-test predictive accuracy or cost-effectiveness |
Systematic review: 53 studies, 2,696 relatives screened |
to Dec 2017 |
Systematic review (genetic 49%, imaging 11%, both 40% of studies) |
(Mariscalco 2018, PMID 30371227) |
| Pathogenic/likely-pathogenic variant in 4.9% of 1,025 unrelated TAAD cases on a 15-gene panel; ~half of variants in nonsyndromic patients without family history; FBN1 the most-hit gene (25/49 variants); yield rises with syndromic features, youth, family history, ascending involvement |
Mixed familial+sporadic UK/Yale cohort |
published 2018 |
Targeted NGS panel |
(Weerakkody 2018, PMID 29543232) |
| Yield 36% when testing is driven by clinical suspicion at a referral center; 57.1% if a known familial mutation exists; 42.3% in root/ascending aneurysm-dissection phenotype |
96 referred, 75 tested; academic center |
2010–2015 |
Retrospective cohort, panel + single-gene testing |
(Hicks 2018, PMID 29510914) |
| Guideline posture: 2022 ACC/AHA guideline covers "genetic evaluation and family screening" as a core management element for aortic disease |
US practice guideline |
2022 |
Guideline |
(Isselbacher 2022, PMID 36334952) |
Interpretation note: the familial-proportion figures (~21%) come from pedigree interview studies at a referral center; the mutation-yield figures (4.9% panel-wide vs 36% suspicion-driven) differ because of cohort selection — present both, never blend.
7. Data infrastructure appendix — the registries behind the numbers
| Registry / dataset |
What it is |
Era |
Scale (verified) |
Access / key description source |
| IRAD — International Registry of Acute Aortic Dissection |
Consecutive AAD cases at large referral centers; presentation, imaging, management, in-hospital and post-discharge outcomes |
1996– |
58 centers in 13 countries (site, 2026); >7,300 cases, >51 sites, 12 countries as of 2018 publication |
(IRAD — "International Registry of Acute Aortic Dissection", https://www.iradonline.org/, accessed 2026-08-27; Evangelista 2018, PMID 29685932; founding cohort: Hagan 2000, PMID 10685714) |
| GERAADA — German Registry for Acute Aortic Dissection Type A |
Multicenter German-speaking registry of operated ATAAD; intraoperative strategy detail (perfusion, arrest times) |
2006– |
56 centers; 3,380–3,385 patients accrued Jul 2006–Jun 2015 |
(Rylski 2021, PMID 31926709; Krüger 2013, PMID 23657546; Farag 2023, PMID 34446289) |
| STS ACSD — Society of Thoracic Surgeons Adult Cardiac Surgery Database |
US/North-American clinical registry of adult cardiac surgery; risk models, proximal aortic and dissection modules |
1989– |
~8.5 million adult cardiac procedure records; >3,500 participating physicians; STS states ~95% coverage of US adult cardiac surgery |
(STS — "STS National Database", https://www.sts.org/sts-national-database, accessed 2026-08-27; aortic analyses: Williams 2012, PMID 22958956; Helder 2020, PMID 31400338) |
| UK NACSA — National Adult Cardiac Surgery Audit (NICOR/NCAP) |
Mandatory UK-wide audit of all adult cardiac surgery incl. thoracic aortic |
2002 analyses onward (audit older) |
534,067 procedures 2002–2016; one of 10 domains of NICOR's National Cardiac Audit Programme |
(NICOR — "National Institute for Cardiovascular Outcomes Research", https://www.nicor.org.uk/, accessed 2026-08-27; Grant 2021, PMID 36003724; TAAD subset: Benedetto 2021, PMID 33963362) |
| GenTAC (legacy) |
US NHLBI longitudinal registry + biorepository of genetically triggered TAA (Marfan, Loeys-Dietz, vEDS, Turner, BAV, familial TAAD) |
Oct 2006–Sep 2016 (closed; legacy biospecimens) |
>3,500 participants; aortic tissue, plasma, DNA, cell lines; open requests via BioLINCC |
(NHLBI BioLINCC — "GenTAC", https://biolincc.nhlbi.nih.gov/studies/gentac/, accessed 2026-08-27; design: Eagle 2009, PMID 19185640) |
| NIS/HCUP — National Inpatient Sample |
All-payer US inpatient administrative database; source of national volume/mortality trend estimates (with ICD-coding caveats) |
1988–2023 |
~20% stratified sample of US community-hospital discharges; ~7 million stays/yr unweighted (~33+ million weighted); AHRQ-sponsored; 2012 redesign to discharge-level sampling |
(AHRQ HCUP — "NIS Overview", https://hcup-us.ahrq.gov/nisoverview.jsp, accessed 2026-08-27; example aortic uses: Chikwe 2013, PMID 23562465; Zimmerman 2016, PMID 27183856) |
| Population register systems |
Sweden (National Patient + Cause of Death Registers), Denmark (National Patient Registry with case validation), Rochester Epidemiology Project (Olmsted), OXVASC (prospective population surveillance) |
varies |
Sweden 8,057 AD 2002–16; Denmark 3,023 validated AD 1996–2016; Olmsted linkage 1995–2015; OXVASC pop. 92,728 |
(Smedberg 2020, PMID 32558879; Obel 2022, PMID 36321467; DeMartino 2018, PMID 30354376; Howard 2013, PMID 23599348) |
8. Known conflicts and caveats — the biggest statistical disagreements
- AAD incidence spans ~2.5–7.2 /100,000/yr depending on ascertainment. Registry/hospital-only designs (Iceland 2.53; Olmsted 3.5) sit far below designs adding death-certificate/autopsy capture (Sweden 7.2 with 29% never hospitalized; OXVASC 6 with 48.6% pre-hospital type A deaths). The meta-analytic 4.8 is a mix of both designs (Melvinsdottir 2016, PMID 27334108; Clouse 2004, PMID 14959911; Smedberg 2020, PMID 32558879; Howard 2013, PMID 23599348; Gouveia e Melo 2022, PMID 34560218).
- TAA prevalence differs 10-fold by method (0.07% clinical-only vs 0.76% autopsy-based): the silent-disease reservoir means clinically ascertained incidence tracks imaging intensity, not biology — the Olmsted tripling (5.9→10.4) coincides with cross-sectional imaging diffusion (Gouveia e Melo 2022, PMID 33705940; Bickerstaff 1982, PMID 7147188; Clouse 1998, PMID 9851478).
- "Is type A mortality improving?" depends on the denominator. IRAD (referral centers, transported survivors) shows in-hospital mortality falling 31%→22% (Pape 2015, PMID 26205591), while validated nationwide Danish data show 30-day mortality flat at 22.0% over 1996–2016 (Obel 2022, PMID 36321467). Referral-bias, survivorship, and era-of-enrollment effects have not been reconciled.
- ICD-coded databases overstate dissection counts. In Denmark only 60.2% of registered AD diagnosis codes survived record validation (Obel 2022, PMID 36321467) — a direct caution for NIS/CDC WONDER trend work, which is coding-based (Chikwe 2013, PMID 23562465; Lv 2026, PMID 41776414).
- The "1–2% per hour" untreated type A figure is folklore-grade in provenance (Hirst 1958, PMID 13577293; Anagnostopoulos 1972, PMID 4557973 — neither abstract retrievable), but order-of-magnitude compatible with the one modern population series that approximates an untreated cohort (50% dead by 24 h after admission; Mészáros 2000, PMID 10807810). It should be quoted as a characterization of untreated historical natural history, not of contemporary managed patients.
- Growth rates vary 20-fold across studies (0.2–4.2 mm/yr) with low study quality and non-standardized measurement; segment (ascending 0.07 cm/yr vs descending 0.19), etiology, and measurement technique explain much of the spread — single "TAA growth rate" numbers are meaningless without segment/etiology (Oladokun 2016, PMID 26947541; Elefteriades 2002, PMID 12440685).
- Yearly rupture/dissection rates by size come from one referral center (Yale) with censoring at operation; the ASI/AHI risk bands are internal re-analyses of overlapping cohorts, and no external population-level replication of the 6.0/7.0 cm hinge points was found this session (Davies 2002, PMID 11834007; Davies 2006, PMID 16368358; Zafar 2018, PMID 29395211).
- GBD "aortic aneurysm" merges thoracic + abdominal disease (and dissection deaths) into one cause, so global TAA-specific deaths/DALYs are strictly unknown; national vital statistics (CDC WONDER) similarly pool aneurysm subtypes in most published analyses (Sampson 2014, PMID 25432126; Wang 2022, PMID 35711350; Lv 2026, PMID 41776414).
- The size paradox is a denominator artifact, not a contradiction: 59% of type A dissections occur below 5.5 cm (Pape 2007, PMID 17709637) while per-person risk at those sizes is low (0.1%/patient-yr at 4.0–5.5 cm; Kim 2016, PMID 27609684) because small aortas vastly outnumber large ones (Paruchuri 2015, PMID 25997607). Quoting either half alone misleads.
Source key (all PMIDs verified against PubMed 2026-08-27)
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- Clouse WD, et al. Improved prognosis of thoracic aortic aneurysms: a population-based study. JAMA. 1998;280:1926-9. PMID 9851478
- Clouse WD, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004;79:176-80. PMID 14959911
- Olsson C, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes... Circulation. 2006;114:2611-8. PMID 17145990
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- Gouveia e Melo R, et al. Systematic review and meta-analysis of the incidence of acute aortic dissections in population-based studies. J Vasc Surg. 2022;75:709-720. PMID 34560218
- Landenhed M, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms. J Am Heart Assoc. 2015;4:e001513. PMID 25609416
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- Mészáros I, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117:1271-8. PMID 10807810
- Melvinsdottir IH, et al. The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study. Eur J Cardiothorac Surg. 2016;50:1111-1117. PMID 27334108
- Smedberg C, et al. Sex differences and temporal trends in aortic dissection: population-based study in Sweden. Eur Heart J. 2020;41:2430-2438. PMID 32558879
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- DeMartino RR, et al. Population-based assessment of the incidence of aortic dissection, intramural hematoma, and penetrating ulcer 1995-2015. Circ Cardiovasc Qual Outcomes. 2018;11:e004689. PMID 30354376
- Hirst AE, et al. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore). 1958;37:217-79. PMID 13577293 (no abstract on PubMed)
- Anagnostopoulos CE, et al. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972;30:263-73. PMID 4557973 (no abstract on PubMed)
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- Pape LA, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from IRAD. J Am Coll Cardiol. 2015;66:350-8. PMID 26205591
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- Hansen MS, et al. Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection. Am J Cardiol. 2007;99:852-6. PMID 17350381
- Harris KM, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection (IRAD). Circulation. 2011;124:1911-8. PMID 21969019
- Coady MA, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg. 1997;113:476-91. PMID 9081092
- Coady MA, et al. Surgical intervention criteria for thoracic aortic aneurysms. Ann Thorac Surg. 1999;67:1922-6. PMID 10391339
- Davies RR, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms. Ann Thorac Surg. 2002;73:17-27. PMID 11834007
- Davies RR, et al. Novel measurement of relative aortic size predicts rupture. Ann Thorac Surg. 2006;81:169-77. PMID 16368358
- Elefteriades JA. Natural history of thoracic aortic aneurysms. Ann Thorac Surg. 2002;74:S1877-80. PMID 12440685
- Zafar MA, et al. Height alone, rather than body surface area, suffices for risk estimation. J Thorac Cardiovasc Surg. 2018;155:1938-1950. PMID 29395211
- Oladokun D, et al. Systematic review of the growth rates and influencing factors in thoracic aortic aneurysms. Eur J Vasc Endovasc Surg. 2016;51:674-81. PMID 26947541
- Kim JB, et al. Risk of aortic dissection in the moderately dilated ascending aorta. J Am Coll Cardiol. 2016;68:1209-1219. PMID 27609684
- Pape LA, et al. Aortic diameter ≥5.5 cm is not a good predictor of type A aortic dissection (IRAD). Circulation. 2007;116:1120-7. PMID 17709637
- Paruchuri V, et al. Aortic size distribution in the general population. Cardiology. 2015;131:265-72. PMID 25997607
- Albornoz G, et al. Familial thoracic aortic aneurysms and dissections. Ann Thorac Surg. 2006;82:1400-5. PMID 16996941
- Williams JB, et al. Contemporary results for proximal aortic replacement in North America. J Am Coll Cardiol. 2012;60:1156-62. PMID 22958956
- Helder MRK, et al. Regional and temporal trends in the outcomes of repairs for acute type A aortic dissections. Ann Thorac Surg. 2020;109:26-33. PMID 31400338
- Chikwe J, et al. National outcomes in acute aortic dissection: influence of surgeon and institutional volume. Ann Thorac Surg. 2013;95:1563-9. PMID 23562465
- Dobaria V, et al. Impact of center volume on outcomes of surgical repair for type A acute aortic dissections. Surgery. 2020;168:185-192. PMID 32507629
- Catalano MA, et al. Age, sex, and contemporary outcomes in surgical repair of type A aortic dissection (NIS). JTCVS Open. 2022;11:23-36. PMID 36172443
- Zimmerman KP, et al. Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample. J Vasc Surg. 2016;64:606-615. PMID 27183856
- Krüger T, et al. Intraoperative neuroprotective drugs... German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg. 2013;44:939-46. PMID 23657546
- Rylski B, et al. Gender-related differences in patients with acute aortic dissection type A (GERAADA). J Thorac Cardiovasc Surg. 2021;162:528-535.e1. PMID 31926709
- Farag M, et al. Early outcomes of patients with Marfan syndrome and acute aortic type A dissection (GERAADA). J Thorac Cardiovasc Surg. 2023;166:25-34.e8. PMID 34446289
- Benedetto U, et al. Neuroprotective strategies in acute aortic dissection: UK National Adult Cardiac Surgical Audit. Eur J Cardiothorac Surg. 2021;60:1437-1444. PMID 33963362
- Grant SW, et al. Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016. JTCVS Open. 2021;7:259-269. PMID 36003724
- Bottle A, et al. Unwarranted variation in the quality of care for patients with diseases of the thoracic aorta. J Am Heart Assoc. 2017;6:e004913. PMID 28292748
- Goodney PP, et al. Survival after open versus endovascular thoracic aortic aneurysm repair (Medicare). Circulation. 2011;124:2661-9. PMID 22104552
- Brown C, et al. The impact of surgeon and hospital procedural volume on outcomes after aortic root replacement in the United States. J Card Surg. 2021;36:2669-2676. PMID 33982345
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- Cefarelli M, et al. Elective aortic arch repair: factors influencing neurologic outcome in 791 patients. Ann Thorac Surg. 2017;104:2016-2023. PMID 28760465
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- Weerakkody R, et al. Targeted genetic analysis in a large cohort of familial and sporadic cases of aneurysm or dissection of the thoracic aorta. Genet Med. 2018;20:1414-1422. PMID 29543232
- Hicks KL, et al. Testing patterns for genetically triggered aortic and arterial aneurysms and dissections at an academic center. J Vasc Surg. 2018;68:701-711. PMID 29510914
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- Isselbacher EM, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. J Am Coll Cardiol. 2022;80:e223-e393. PMID 36334952
Portal pages fetched 2026-08-27: IRAD (https://www.iradonline.org/), STS National Database (https://www.sts.org/sts-national-database), NICOR (https://www.nicor.org.uk/), HCUP NIS Overview (https://hcup-us.ahrq.gov/nisoverview.jsp), NHLBI BioLINCC GenTAC (https://biolincc.nhlbi.nih.gov/studies/gentac/). IHME GBD factsheet fetch attempted and blocked (HTTP 403).