A 60-year-old man with hypertension is found on chest CT to have an asymptomatic descending thoracic aortic aneurysm measuring 6.2 cm in maximum diameter. He is otherwise fit with good functional reserve. What is the recommended management?

• A Serial imaging yearly until the diameter reaches 8 cm
• B Repair only if the patient becomes symptomatic
• C Beta blocker therapy alone with no surveillance imaging
• D Repair, endovascular where anatomy permits, given the diameter exceeds the 6 cm threshold ✓

Explanation

For descending thoracic aortic aneurysms, repair is advised once the diameter reaches approximately 6 cm in fit patients, or earlier if the aneurysm is symptomatic, rapidly expanding, or associated with a connective tissue disorder such as Marfan syndrome. Endovascular thoracic stent grafting is now the preferred modality when landing zones permit. Waiting until 8 cm invites rupture or dissection, since annual expansion averages roughly 0.1 cm per year and rupture risk rises sharply beyond 6 cm. Beta blockade slows expansion but does not replace repair at threshold size.

Reference: Sabiston Textbook of Surgery, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.