# Beyond the Echo: Is Comprehensive Vascular Exploration Valuable in Cases of Non-Syndromic Thoracic Aortic Aneurysms or Bicuspid Aortic Valve?

## TL;DR

This study examines whether non-syndromic aortic valve or aortic aneurysm cases require comprehensive vascular screening.

## Contribution

The study provides evidence against routine comprehensive vascular screening for non-syndromic BAV or TAAD patients.

## Key findings

- 44.6% of patients had BAV or TAAD, and 27.2% had multiple arteriopathies.
- No significant increased risk of extra-aortic arteriopathies was found in BAV or TAAD cohorts.
- Targeted imaging is recommended over broad screening for non-syndromic cases.

## Abstract

Bicuspid aortic valve (BAV) and thoracic aortic aneurysms and dissections (TAAD) are recognized in syndromic connective tissue diseases (CTD), but most cases occur sporadically. The extent to which non-syndromic BAV or TAAD predisposes to additional arteriopathies, particularly in younger individuals, remains unclear. We retrospectively analyzed 1438 patients (mean age = 48.0, 67.7% female), excluding those with CTDs. Participants were ≤60 years old and categorized by the presence of BAV and/or TAAD. We examined co-existing arterial pathologies, including fibromuscular dysplasia, spontaneous coronary artery dissection, abdominal aortic aneurysms (AAA), mesenteric, peripheral extremity, and carotid/cerebral arteriopathies. Overall, 44.6% had either BAV or TAAD, and 27.2% had multiple arteriopathies. While vascular diseases were frequently noted, odds ratios demonstrated no significantly increased risk of extra-aortic arteriopathies in the BAV or TAAD cohorts. AAA exhibited a non-significant trend toward higher prevalence in TAAD patients. These findings support current guidelines recommending targeted imaging (transthoracic echocardiography of the aortic root and ascending aorta) over comprehensive “head-to-pelvis” screening for non-syndromic BAV or TAAD patients without additional risk factors. Ongoing genetic analyses may elucidate whether particular variants predispose to multi-site aneurysms or dissections. Consequently, targeted surveillance remains appropriate, with broader imaging reserved for patients with genetic or clinical indicators of higher risk.