“Getting beyond diameter”: when to replace the aorta?

Timely surgical intervention is of paramount importance in thoracic aortic aneurysm (TAA) patients in order to avoid the catastrophic complications of rupture, dissection and death. Various parameters have emerged that can aid in timing prophylactic surgical repair more accurately in TAA patients by supplementing and refining the traditional aortic size-based threshold for intervention: (I) surgical treatment of symptomatic TAAs regardless of aortic size; (II) indexing aortic size in relation to patient’s height and body surface area; (III) impact of female gender on TAA disease prognosis; (IV) consideration of anatomical aberrations of the aorta (bovine aortic arch); (V) prognostic importance of family history in predicting aortic dissection; (VI) prognostic significance of specific genetic mutations; (VII) non-size bioengineering criteria to estimate disease severity; (VIII) use of biomarkers to diagnose and monitor progression of TAA; (IX) application of advanced imaging techniques to identify and quantify disease progression in the aneurysmal aorta; (X) increasing safety of aortic surgery in the present era.