Strengthening Aortic Aneurysm Screening Strategies to Save More Lives

This Clinician’s View is written by cardiothoracic surgeon Ioannis Loumiotis, MD, Director of Aortic Surgery, AdventHealth Orlando.

Aortic aneurysms occur in approximately 5–10 per 100,000 individuals and remain a largely silent but potentially catastrophic condition. While we know early detection and intervention can save lives, an estimated 90–95% of patients are asymptomatic. When symptoms do appear, they typically signal advanced disease.

Too often, the first indication of an aneurysm is aortic rupture or dissection. At that stage, outcomes are poor. Mortality rates approach 80–90% for abdominal aortic aneurysm rupture and exceed 90% for thoracic aortic aneurysms.

Current guidelines from the Society for Vascular Surgery and the American Academy of Family Physicians recommend one-time ultrasound screening for abdominal aortic aneurysm in men aged 65 to 75 years with a history of smoking. While this recommendation has helped identify some at-risk individuals, additional strategies are needed to strengthen screening, particularly for thoracic aortic aneurysms.

Earlier detection enables more timely intervention before an aneurysm progresses to a life-threatening event. Patients can be closely monitored, medically optimized and scheduled for elective repair under controlled conditions. This is critical as mortality associated with elective aneurysm repair is significantly lower than that associated with emergency surgery following a rupture.

By working together to implement stronger, more consistent screening practices, we can identify aneurysms earlier, intervene more effectively and ultimately save lives.

Building a More Robust Screening Protocol

Aortic aneurysms are chronic, progressive conditions, and their asymptomatic nature makes diagnosis through screening challenging but not impossible. While men older than 65 years with a history of smoking should continue to be referred for abdominal aortic ultrasound, additional risk indicators should also inform screening strategies.

Thanks to groundbreaking work by John A. Elefteriades, MD, we now know that there are several clinical “associates” of thoracic aortic aneurysm that can aid in identification of this silent disease:

• Intracranial aneurysm
• Aortic arch anomalies
• Abdominal aortic aneurysm
• Simple renal cysts
• Bicuspid aortic valve
• Temporal arteritis
• Positive family history of aneurysm disease
• Positive thumb-palm sign, an indication of excessive joint laxity that is often associated with connective tissue disorders like Marfan syndrome

In addition to age and smoking history, aortic aneurysm screening efforts should include a more detailed family history. Key questions can help identify patients at increased risk:

• Do you have any family history of sudden cardiac death, aortic aneurysm, aortic dissection, bicuspid aortic valve, or connective tissue disease?
• Has anyone in your family died suddenly at a young age without a known cause and no prior symptoms?

The rationale for the second question is that relatively few conditions lead to sudden death in otherwise asymptomatic individuals, and aortic disease is among them. For example, a patient who reports that a parent died suddenly at age 45 with no known diagnosis should be considered at elevated risk for underlying aortic pathology.

Patients who answer “yes” to any of these questions should be considered higher risk and referred for transthoracic echocardiography (TTE). Depending on the findings, further imaging with computed tomography (CT) or magnetic resonance imaging (MRI) may be warranted.

Early Intervention Leads to Better Outcomes

Why is this important? Enhanced screening for aortic aneurysm allows clinicians to intervene electively rather than in emergency situations, resulting in significantly better outcomes. Studies consistently demonstrate that mortality rates for emergency aortic aneurysm repair are two to five times higher than those for elective procedures.

Elective surgery allows for careful optimization of comorbidities, thorough preoperative imaging and planning, and treatment by experienced aortic surgical teams. In addition to preventing aortic rupture or acute dissection, this approach is associated with fewer perioperative complications and improved long-term outcomes and quality of life.

AdventHealth’s Aortic Center – Providing Lifelong, Multidisciplinary Care

The 2022 American Heart Association/American College of Cardiology Guideline for the Diagnosis and Management of Aortic Disease emphasizes the importance of shared decision-making between patients and a multidisciplinary aortic team to determine the optimal medical, endovascular, and open surgical therapies. AdventHealth’s aortic care team, led by high-volume specialists, collaborates closely with patients and referring physicians to manage aortic disease and reduce the risk of adverse aortic events.

Timely referral and intervention are essential to achieving the best possible outcomes. Patients should be referred to an aortic specialist well before surgical thresholds are reached. We recommend referral to our aortic center for further evaluation in the following situations:

1. Aortic diameter greater than 4 centimeters
2. Evidence of rapid aortic growth (0.3 to 0.5 cm per year)
3. Any aortic dilation in young patients
4. Bicuspid aortic valve disease
5. Genetic or familial history of aortic aneurysm

Our multidisciplinary team is committed to providing lifelong care for patients with aortic disease. Medical management always comes first and includes education along with risk factor modification. Surgical intervention is pursued only when established thresholds are reached, ensuring the highest standards of safety and optimal outcomes.

To further enhance care coordination, AdventHealth plans to add a dedicated nurse navigator to our aortic care team later this year.

Although aortic disease is silent and asymptomatic, it is rarely truly sudden. With greater awareness, structured screening protocols and consistent surveillance, we can identify risk earlier and intervene proactively. Working together, we can shift the course of this disease from reacting to catastrophic emergencies to preventing them, ensuring more patients receive timely, life-saving care.