Introduction

Diseases of the thoracic aorta are increasing in prevalence. In the UK, there has been a steady rise in admissions for thoracic aortic dissection (TAD) from 7.2 to 8.8 per 100 000 population over the last decade.1 At the same time, admissions for thoracic aortic aneurysms (TAA) have increased from 4.4 to 9.0 per 100 000. Thoracic aortic disease is deadly; most patients with TAA are likely to die of a complication attributable to their aneurysm, accounting for up to 47 000 deaths annually in the USA.2 TAD affecting the ascending aorta has a 30-day mortality of 25–50%.3 The increase in numbers of patients presenting with disease of the thoracic aorta is predominantly due to an increase in elderly patients, over 75 years of age.1 This means that the upward trend is likely to continue as the population ages, and that these patients are more likely to suffer from multiple additional comorbid conditions, presenting greater challenges for clinicians. In the face of this increasing problem, our understanding of the pathophysiology and natural history of this condition remains poor. Aortic disease is readily amenable to treatment; mortality rates for surgery and thoracic endovascular aortic repair (TEVAR) are low, and in fact, overall mortality rates for patients hospitalised with thoracic aortic disease are decreasing.1 However, there is wide variation in the management of these patients; in the UK, the number of complex aortic surgical procedures varies widely between cardiac centres despite comparable geographical populations (figure 1). This reflects uncertainty as to the appropriate indications for, and modality of treatment. In this edition …