From the Guidelines
Thoracic aortic aneurysms require intervention when they reach a diameter of ≥6.0 cm, but intervention may be considered at smaller diameters (≥5.5 cm) in certain cases, such as when performed by experienced surgeons in a Multidisciplinary Aortic Team or in patients with features associated with an increased risk of rupture. The decision to intervene is based on the balance between the risk of rupture or dissection and the risks of surgical intervention 1. Several factors influence this decision, including:
- The diameter of the aneurysm, with larger diameters indicating a higher risk of rupture 1
- The presence of features associated with an increased risk of rupture, such as rapid growth, symptoms, penetrating ulcers, mycotic aneurysms, or connective tissue disorders 1
- The expertise of the surgical team and the availability of a Multidisciplinary Aortic Team 1
- The patient's overall health and presence of comorbid conditions, which may affect the risks of surgical intervention 1
In general, intervention is recommended for intact degenerative thoracic aortic aneurysms (TAAAs) when the diameter is ≥6.0 cm 1. However, intervention may be considered at smaller diameters (≥5.5 cm) when performed by experienced surgeons in a Multidisciplinary Aortic Team 1. Additionally, patients with features associated with an increased risk of rupture may undergo repair at diameters <5.5 cm 1. The goal of intervention is to reduce the risk of aortic-related events and death, while minimizing the risks of surgical intervention 1.
From the Research
Width of Thoracic Aortic Aneurysms Requiring Intervention
- The width of thoracic aortic aneurysms that require intervention varies depending on the location and other risk factors, as indicated by studies 2, 3, 4.
- For ascending aortic aneurysms, a size of 5.5 cm is recommended as an acceptable size for elective resection, as stated in the study 2.
- For descending aortic aneurysms, a size of 6.5 cm is recommended for intervention, according to the study 2.
- The European Society for Vascular Surgery guidelines recommend elective treatment of thoracic aneurysms with a diameter > 55 mm, as mentioned in the study 3.
- The risk of rupture increases with aneurysm size, and the incidence of dissection or rupture is higher for larger aneurysms, as reported in the study 2.
- Other factors such as rate of growth, associated conditions, and medical management also play a crucial role in determining the need for intervention, as discussed in the studies 4, 5.