Ascending and arch aorta: pathology, natural history, and treatment.

Aortic aneurysms are the 13th-leading cause of mortality in the United States.1 The incidence of thoracic aortic aneurysms (TAA) is increasing with improvements in screening, as well as advances in imaging.2 Replacement of the ascending aorta accounts for the majority of thoracic aortic procedures. TAAs are more frequently present in men and typically occur in the 50to 70-year age range.3 Disease processes affecting the ascending and arch aorta include degenerative aneurysms and aneurysms associated with connective tissue disease, as well as acute aortic dissection and its variants of intramural hematoma and penetrating ulcer. Syphilitic aneurysms, once the predominant cause of ascending aneurysms, are exceedingly rare today. In the present review, we will discuss these pathological conditions as well as operative techniques and outcomes after medical and operative therapy.