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Diseases of the Aorta resonance angiography (MRA). Echocardiography is obtained l(EY POIilTS ((J,ntinufd,) in patients with a bicuspid aorlic valve. o Thoracic endovascular aortic repair is recommended in patients with a descending aortic aneurysm when the Treatment diameter is greater than 6.0 cm, has exhibited rapid TAAs with a diameter smaller than 5.0 cm usually can be man growth (>0.5 cm/year), or has caused end-organ damage. aged with medical therapy and active surveillance. Medical therapy includes aggressive blood pressure control with a goal blood pressure below 130/80 mm Hg. B Blockers are the pre Abdominal Aortic Aneurysm f'erred antihypertensive agents in patients with TAA. In patients Abdominal aortic aneurysm (AAA) is abnormal dilatation of the with Marfan syndrome, B-blockers and losarlan have been abdominal aorta with an anteroposterior diameter greater than associated with a reduced rate of aneurysm growth. 3.0 cm. Risk factors include male sex (6:1 male to female inci When an ascending aortic aneurysm due to degenera dence ratio), advanced age, smoking, atherosclerosis, hypefien tive disease exceeds 5.5 cm in diameter or has rapid growth sion, and a family history of AAA. (>0.5 cm/year), surgical repair is warranted to prevent the morbidity and mortality associated with rupture. In patients Screening and Surveillance with an ascending aorta or aortic root larger than 4.5 cm in AAA most often is diagnosed incidentally by CTA or abdominal diameter who require surgery tbr coronary artery disease ultrasonography. Approximately 75')(, of patients with AAA are (CAD) or valve pathology, aortic repair should be performed asymptomatic at the time of diagnosis. Because of the high at the time of cardiac surgery. Current guidelines recom mortality rate associated with aneurysm rupture, the U.S. mend that all patients with a bicuspid aortic valve and Preventive Services Task Force recommends one-time screen ascending aortic aneurysm undergo aortic repair when the ing with duplex ultrasonography in men aged 65 to 75 years aneurysm exceeds 5.5 cm in diameter, unless an additional who have smoked at least 100 cigarettes during their lifetime risk factor for dissection is present or the patient is at low and selective screening for men in this same age group who operative risk, in which case aortic repair is reasonable at have never smoked. .5.0 cm. In patients with Marfan syndrome or another genet Estimated annual risk for aoftic rupture according to AAA ically mediated disorder, the American College of Cardiologi/ dimension is shown in Table 37. In patients with AAA diameter American Heart Association guidelines suggest elective aor' smaller than 4.0 cm, surveillance with duplex ultrasonography tic repair at a lower threshold (4.0 5.0 cm, depending on the every 2 to 3 years is warranted. In patients with AAA diameter of condition). 4.0 to less than 5.5 cm, surveillance with CIA or duplex ultra Aneurysm location, aortic valve pathologr, and the pres- sonography should be perlormed every 6 to 12 months. Once the ence of concomitant CAD dictate the type of thoracic aofiic aortic diameter meets the threshold for aortic repair (>5.5 cm), repair performed. Open surgical repair is indicated for TAAs CTA or MRA is indicated to determine the exact location of the that involve the aortic root, ascending aorta, and aorlic arch. AAA (suprarenal, juxtarenal, or infrarenal) for planning repair' Thoracic endovascular aortic repair (TEVAR) with stent graft ing should be used when a descending aortic aneurysm has a Treatment diameter greater than 6.0 cm, has exhibited rapid growth Medical treatment of AAA involves risk factor reduction to (>0.5 cm/year), or has caused end organ damage, because decrease risk for rupture, cardiovascular morbidity, and TEVAR has a lower morbidity and shorter hospital stay relative to open surgical repair. TEVAR offers the advantage ofavoiding TABLE 37. Annual Rupture Risk of Abdominal Aortic open surgery although complications, such as stroke, spinal Aneurysm by Diameter ischemia, and aortic graft endoleaks, can occur. Aneurysm Diameter Annual Rupture Risk r(EY P0r1{rS <0.5% <4.0 cm o Asymptomatic patients with a bicuspid aortic valve, 0.57o-57" 4.0-4.9 cm genetic condition that predisposes to aortic aneurysms 5.0-5.9 cm 3/o-15"/" and dissections, or family history of thoracic aortic 6.0-6.9 cm 10%-20% aneurysm or aortic dissection should undergo screening for abnormalities of the thoracic aorta. 7.0-7.9 cm 20%-407"

resonance angiography (MRA). Echocardiography is obtained l(EY POIilTS ((J,ntinufd,) in patients with a bicuspid aorlic valve. o Thoracic endovascular aortic repair is recommended in patients with a descending aortic aneurysm when the Treatment diameter is greater than 6.0 cm, has exhibited rapid TAAs with a diameter smaller than 5.0 cm usually can be man growth (>0.5 cm/year), or has caused end-organ damage. aged with medical therapy and active surveillance. Medical therapy includes aggressive blood pressure control with a goal blood pressure below 130/80 mm Hg. B Blockers are the pre Abdominal Aortic Aneurysm f'erred antihypertensive agents in patients with TAA. In patients Abdominal aortic aneurysm (AAA) is abnormal dilatation of the with Marfan syndrome, B-blockers and losarlan have been abdominal aorta with an anteroposterior diameter greater than associated with a reduced rate of aneurysm growth. 3.0 cm. Risk factors include male sex (6:1 male to female inci When an ascending aortic aneurysm due to degenera dence ratio), advanced age, smoking, atherosclerosis, hypefien tive disease exceeds 5.5 cm in diameter or has rapid growth sion, and a family history of AAA. (>0.5 cm/year), surgical repair is warranted to prevent the morbidity and mortality associated with rupture. In patients Screening and Surveillance with an ascending aorta or aortic root larger than 4.5 cm in AAA most often is diagnosed incidentally by CTA or abdominal diameter who require surgery tbr coronary artery disease ultrasonography. Approximately 75')(, of patients with AAA are (CAD) or valve pathology, aortic repair should be performed asymptomatic at the time of diagnosis. Because of the high at the time of cardiac surgery. Current guidelines recom mortality rate associated with aneurysm rupture, the U.S. mend that all patients with a bicuspid aortic valve and Preventive Services Task Force recommends one-time screen ascending aortic aneurysm undergo aortic repair when the ing with duplex ultrasonography in men aged 65 to 75 years aneurysm exceeds 5.5 cm in diameter, unless an additional who have smoked at least 100 cigarettes during their lifetime risk factor for dissection is present or the patient is at low and selective screening for men in this same age group who operative risk, in which case aortic repair is reasonable at have never smoked. .5.0 cm. In patients with Marfan syndrome or another genet Estimated annual risk for aoftic rupture according to AAA ically mediated disorder, the American College of Cardiologi/ dimension is shown in Table 37. In patients with AAA diameter American Heart Association guidelines suggest elective aor' smaller than 4.0 cm, surveillance with duplex ultrasonography tic repair at a lower threshold (4.0 5.0 cm, depending on the every 2 to 3 years is warranted. In patients with AAA diameter of condition). 4.0 to less than 5.5 cm, surveillance with CIA or duplex ultra Aneurysm location, aortic valve pathologr, and the pres- sonography should be perlormed every 6 to 12 months. Once the ence of concomitant CAD dictate the type of thoracic aofiic aortic diameter meets the threshold for aortic repair (>5.5 cm), repair performed. Open surgical repair is indicated for TAAs CTA or MRA is indicated to determine the exact location of the that involve the aortic root, ascending aorta, and aorlic arch. AAA (suprarenal, juxtarenal, or infrarenal) for planning repair' Thoracic endovascular aortic repair (TEVAR) with stent graft ing should be used when a descending aortic aneurysm has a Treatment diameter greater than 6.0 cm, has exhibited rapid growth Medical treatment of AAA involves risk factor reduction to (>0.5 cm/year), or has caused end organ damage, because decrease risk for rupture, cardiovascular morbidity, and TEVAR has a lower morbidity and shorter hospital stay relative to open surgical repair. TEVAR offers the advantage ofavoiding TABLE 37. Annual Rupture Risk of Abdominal Aortic open surgery although complications, such as stroke, spinal Aneurysm by Diameter ischemia, and aortic graft endoleaks, can occur. Aneurysm Diameter Annual Rupture Risk r(EY P0r1{rS <0.5% <4.0 cm o Asymptomatic patients with a bicuspid aortic valve, 0.57o-57" 4.0-4.9 cm genetic condition that predisposes to aortic aneurysms 5.0-5.9 cm 3/o-15"/" and dissections, or family history of thoracic aortic 6.0-6.9 cm 10%-20% aneurysm or aortic dissection should undergo screening for abnormalities of the thoracic aorta. 7.0-7.9 cm 20%-407" . In patients with an ascending aortic diameter exceeding >8.0 cm 307" 50"/"

resonance angiography (MRA). Echocardiography is obtained l(EY POIilTS ((J,ntinufd,) in patients with a bicuspid aorlic valve. o Thoracic endovascular aortic repair is recommended in patients with a descending aortic aneurysm when the Treatment diameter is greater than 6.0 cm, has exhibited rapid TAAs with a diameter smaller than 5.0 cm usually can be man growth (>0.5 cm/year), or has caused end-organ damage. aged with medical therapy and active surveillance. Medical therapy includes aggressive blood pressure control with a goal blood pressure below 130/80 mm Hg. B Blockers are the pre Abdominal Aortic Aneurysm f'erred antihypertensive agents in patients with TAA. In patients Abdominal aortic aneurysm (AAA) is abnormal dilatation of the with Marfan syndrome, B-blockers and losarlan have been abdominal aorta with an anteroposterior diameter greater than associated with a reduced rate of aneurysm growth. 3.0 cm. Risk factors include male sex (6:1 male to female inci When an ascending aortic aneurysm due to degenera dence ratio), advanced age, smoking, atherosclerosis, hypefien tive disease exceeds 5.5 cm in diameter or has rapid growth sion, and a family history of AAA. (>0.5 cm/year), surgical repair is warranted to prevent the morbidity and mortality associated with rupture. In patients Screening and Surveillance with an ascending aorta or aortic root larger than 4.5 cm in AAA most often is diagnosed incidentally by CTA or abdominal diameter who require surgery tbr coronary artery disease ultrasonography. Approximately 75')(, of patients with AAA are (CAD) or valve pathology, aortic repair should be performed asymptomatic at the time of diagnosis. Because of the high at the time of cardiac surgery. Current guidelines recom mortality rate associated with aneurysm rupture, the U.S. mend that all patients with a bicuspid aortic valve and Preventive Services Task Force recommends one-time screen ascending aortic aneurysm undergo aortic repair when the ing with duplex ultrasonography in men aged 65 to 75 years aneurysm exceeds 5.5 cm in diameter, unless an additional who have smoked at least 100 cigarettes during their lifetime risk factor for dissection is present or the patient is at low and selective screening for men in this same age group who operative risk, in which case aortic repair is reasonable at have never smoked. .5.0 cm. In patients with Marfan syndrome or another genet Estimated annual risk for aoftic rupture according to AAA ically mediated disorder, the American College of Cardiologi/ dimension is shown in Table 37. In patients with AAA diameter American Heart Association guidelines suggest elective aor' smaller than 4.0 cm, surveillance with duplex ultrasonography tic repair at a lower threshold (4.0 5.0 cm, depending on the every 2 to 3 years is warranted. In patients with AAA diameter of condition). 4.0 to less than 5.5 cm, surveillance with CIA or duplex ultra Aneurysm location, aortic valve pathologr, and the pres- sonography should be perlormed every 6 to 12 months. Once the ence of concomitant CAD dictate the type of thoracic aofiic aortic diameter meets the threshold for aortic repair (>5.5 cm), repair performed. Open surgical repair is indicated for TAAs CTA or MRA is indicated to determine the exact location of the that involve the aortic root, ascending aorta, and aorlic arch. AAA (suprarenal, juxtarenal, or infrarenal) for planning repair' Thoracic endovascular aortic repair (TEVAR) with stent graft ing should be used when a descending aortic aneurysm has a Treatment diameter greater than 6.0 cm, has exhibited rapid growth Medical treatment of AAA involves risk factor reduction to (>0.5 cm/year), or has caused end organ damage, because decrease risk for rupture, cardiovascular morbidity, and TEVAR has a lower morbidity and shorter hospital stay relative to open surgical repair. TEVAR offers the advantage ofavoiding TABLE 37. Annual Rupture Risk of Abdominal Aortic open surgery although complications, such as stroke, spinal Aneurysm by Diameter ischemia, and aortic graft endoleaks, can occur. Aneurysm Diameter Annual Rupture Risk r(EY P0r1{rS <0.5% <4.0 cm o Asymptomatic patients with a bicuspid aortic valve, 0.57o-57" 4.0-4.9 cm genetic condition that predisposes to aortic aneurysms 5.0-5.9 cm 3/o-15"/" and dissections, or family history of thoracic aortic 6.0-6.9 cm 10%-20% aneurysm or aortic dissection should undergo screening for abnormalities of the thoracic aorta. 7.0-7.9 cm 20%-407" . In patients with an ascending aortic diameter exceeding >8.0 cm 307" 50"/" 5.5 cm or demonstrating rapid growth (>0.5 cm/year), Reproduced with permission from Brewster DC, Cronenwett JL' Hallett JW Jr, et al; Joint Counci of the American Association forVascular Surgery and Societyfor aortic repair is warranted to prevent the morbidity and Vascular Surgery. Guidelines for the treatment o{ abdominal aortic aneurysms' mortality associated with aneurysm rupture; patients Report of a subiommittee o{ the Joint Council o{ the American Association for Vaicular Su rgery and Society for Vascular Su rgery. J Vasc Surg.2003;37:1 106 11 ' with genetically mediated disorders should undergo IPM lD: 1 27563631 d oiiAl06l /mva.2O03.363. 02003 Society for Vascular Surgery ind The American Association for Vascular Surgery. Published by Elsevier lnc' All aortic repair at a lower threshold. (Continued) rights reserued.

5.5 cm or demonstrating rapid growth (>0.5 cm/year), Reproduced with permission from Brewster DC, Cronenwett JL' Hallett JW Jr, et al; Joint Counci of the American Association forVascular Surgery and Societyfor aortic repair is warranted to prevent the morbidity and Vascular Surgery. Guidelines for the treatment o{ abdominal aortic aneurysms' mortality associated with aneurysm rupture; patients Report of a subiommittee o{ the Joint Council o{ the American Association for Vaicular Su rgery and Society for Vascular Su rgery. J Vasc Surg.2003;37:1 106 11 ' with genetically mediated disorders should undergo IPM lD: 1 27563631 d oiiAl06l /mva.2O03.363. 02003 Society for Vascular Surgery ind The American Association for Vascular Surgery. Published by Elsevier lnc' All aortic repair at a lower threshold. (Continued) rights reserued. 101