Treatment-aortic aneurysms

(Circ 2010;121:e266 & 2016;133:680; JACC 2020;76:201; NEJM 2021;385:1690)

• Goal is to prevent rupture (50% mortality prior to hospital) by modifying risk factors
• Risk factor modification: smoking cessation; statins to achieve LDL-C <70 mg/dL
• BP control (goal SBP 100–120): βB (↓ dP/dt) ↓ aneurysm growth; ACEI a/w ↓ rupture risk (Lancet 2006;368:659); ARB may ↓ rate of aortic root growth in Marfan (NEJM 2008;358:2787)
• Mod CV exercise OK, no burst activity requiring Valsalva maneuvers (eg, heavy lifting)
• Indications for intervention (individualized based on FHx, body size, sex, anatomy) TAA: sxs; ascending Ao ≥5.5 cm (4–5 cm if Marfan, L-D, EDS, bicuspid AoV); descending Ao >6 cm; ≥4.5 cm and planned AoV surgery; ↑ >0.5 cm/y AAA: sx; infrarenal ≥5.5 cm; consider ≥5.0 cm in ♀; ↑ >0.5 cm/y; inflam/infxn