When is surgery recommended for an enlarged aorta or aortic aneurysm?

Surgery is recommended in order to prevent an aortic catastrophe, including aortic rupture or aortic dissection.  An aortic rupture is typically a fatal event.  An aortic dissection is associated with a high rate of death as well as other serious complications including heart attack, stroke, and paralysis.  

The risk of aortic catastrophe increases with aortic size:  

• For aneurysms less than 5 cm, the risk of is approx 4-6% per year  
  
• At 5 - 6 cm, the risk increases to as much as 12% per year 
  
• At 7 cm, it exceeds 25% per year.  

Given these risks, surgery is usually recommended for patients with  aneurysms 5.0 - 5.5 cm in diameter.  However, this threshold may vary depending on other patients factors.  Surgery is recommended for patients with smaller aneurysms if they have:

• symptoms related to the aneurysm, 
  
• other heart disease requiring surgery, 
  
• a bicuspid aortic valve, 
  
• strong family history, and/or 
  
• connective tissue disease such as Marfan's or Lowy Dietz.   

Indications for aortic aneurysm replacement

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How is the specific treatment determined?

Specific treatment will be determined by your physician based on:  

• age
  
• overall health and medical history  
  
• size and extent of the disease, 
  
• signs and symptoms, 
  
• tolerance of specific medications, procedures or therapies, 
  
• expectations for the course of the disease, and 
  
• patient preferences.

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How can I prevent an aortic dissection  and/or further growth of an aneurysm?   

You can help prevent an aortic dissection and/or further growth of an aneurysm by doing the following:

• Control your blood pressure. If you have high blood pressure, get a home blood pressure measuring device to help you monitor and keep your blood pressure well controlled.
  
• Don't smoke. Or, if you do, take steps to stop.
  
• Maintain an ideal weight. Follow a low-salt diet and exercise regularly.
  
• Watch your cholesterol. Keep your cholesterol levels within a range that is recommended by your doctor.
  
• Continue low-impact exercise (eg brisk walking).  Avoid high-impact exercise that significantly increases your blood pressure (eg weight training)
  
• Wear a seat belt. This reduces the risk of traumatic injury to your chest area.
  
• Keep your doctor well-informed. If you have a family history of aortic dissection, let your doctor know.

How Can We Help You?

• Find a cardiologist or heart surgeon
  
• Request an appointment with a heart care expert
• Request a second opinion
• Find a clinical trial

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Ask Our Experts
Submit your non-urgent questions regarding your aortic, heart, and vascular conditions via email to our expert team of doctors.

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Preparation

• Preparing for Your Appointment
• Preparing for Your Surgery
• Preparing for Your Hospital Stay
• Recovering from surgery

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FAQ

What is an enlarged aorta?  
An enlarged aorta is also known as an aortic aneurysm...

What is transcatheter aortic valve implantation (TAVI)?  
TAVI also known as transcatheter aortic valve reimplantation (TAVR)...

Can I exercise if I have an enlarged aorta, aortic aneurysm, or chronic dissection?  
Though some types of exercise should be avoided, exercise is generally encouraged...

Who should be screened for an aortic aneurysm?
Most people with aortic aneurysms experience no symptoms...