LDS Aortic Surveillance Protocol — EECC MCQ

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ModerateAortic DiseaseLDS Aortic Surveillance ProtocolEECC

A 55-year-old man with Loeys-Dietz syndrome asks about surveillance imaging for his aorta. His ascending aorta is currently 38 mm. What imaging modality and frequency are recommended?

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Correct answer: A — Image the entire aorta by MRI at size-based intervals

Loeys-Dietz syndrome causes diffuse arteriopathy affecting the ENTIRE arterial tree (not just the aortic root as in Marfan). The ESC 2024 Aortic Disease Guidelines recommend: (1) MRI from head to pelvis ('head-to-toe' angiography) at baseline to identify all aneurysms; (2) serial surveillance: annually if aorta <40 mm; 6-monthly if 40-45 mm or rapid growth; (3) MRI preferred over CT (no cumulative radiation — patients require lifelong imaging, often starting in childhood/young adulthood); (4) include ALL arterial beds: cerebrovascular (carotid, vertebral), thoracic aorta, abdominal aorta, iliac, and peripheral arteries — aneurysms and dissections can occur at ANY site; (5) lower surgical threshold than Marfan (42-45 mm for ascending aorta depending on mutation). CT is used when MRI is unavailable or for surgical planning. Echocardiography underestimates aortic dimensions and cannot visualise the entire aorta.

Reference: ESC (2024): Aortic Disease Guidelines: https://bnf.nice.org.uk/