Real-world adherence to guideline-directed imaging surveillance in chronic aortic dissection and thoracic aortic aneurysm: a scoping review.

BACKGROUND: Guideline-directed imaging surveillance (GDIS) is recommended after aortic dissection (AD) and for thoracic aortic aneurysm (TAA); however, real-world adherence and outcomes are uncertain. METHODS: Following PRISMA-ScR guidance, we searched six databases from inception through May 2026 for studies from the United States or Canada reporting imaging surveillance or clinical follow-up after AD or for TAA. Two reviewers independently screened records and extracted data on surveillance rates, cohort characteristics, radiographic findings, interventions, and survival. Findings were synthesized narratively. RESULTS: Across 13 retrospective studies, enrollments included 1,344 patients with Type A AD, 865 with Type B AD (357 treated invasively at index hospitalization and 508 initially treated medically), 533 with repaired TAA, and 29,185 with unrepaired TAA. Definitions and surveillance intervals varied, and most studies were single-center chart reviews. Adherence to GDIS was generally low and variable. Surveillance was associated with detection of adverse radiographic findings and higher intervention rates. Among studies evaluating survival, two associated imaging surveillance with lower mortality, three reported nonsignificant trends toward lower mortality, and two associated greater surveillance with higher mortality. Few studies used regional or national data capable of capturing surveillance outside the primary health system. CONCLUSIONS: Real-world adherence to GDIS for AD and TAA is low and heterogeneous. Surveillance identifies clinically important radiographic findings and is associated with more interventions, but associations with improved survival remains limited. Multicenter studies using regional or national data systems are needed to define effective, risk-based surveillance intervals and inform implementation strategies.