Aortic Aneurysm and Dissection Management

Diagnosis and Pathophysiology

The American College of Radiology recommends that aortic aneurysms be managed electively with surveillance and planned surgical intervention based on size (≥5.5 cm for the ascending aorta, ≥6.0 cm for the descending aorta) 1, 2
Aortic dissection requires immediate intervention, with surgical treatment for type A and medical intensive treatment for uncomplicated type B 1, 2
The risk of rupture increases progressively with the size of the aneurysm, doubling with each centimeter beyond 5 cm 1
The annual risk of rupture is 7% for aneurysms of 6.0-6.5 cm 1, 2

The European Heart Journal recommends beta-blockers as first-line treatment for aortic dissection, with a target systolic blood pressure of 100-120 mmHg and heart rate ≤60 bpm 3, 4, 8
The American College of Radiology recommends elective surgical intervention for aortic aneurysms based on size, with options for surgical or endovascular approach 1, 2
The European Heart Journal recommends TEVAR as the preferred intervention for complicated type B dissections 9, 3, 4

The European Heart Journal recommends regular imaging surveillance to detect growth of the aneurysm or dissection, with MRI as the technique of choice for surveillance 5, 6, 7
The American College of Radiology recommends continued blood pressure control with beta-blockers and monitoring for signs of complications or progression to surgical thresholds 1, 2
The European Heart Journal recommends re-intervention for chronic dissection if the aorta becomes aneurysmal (5-6 cm) 5, 6, 7

The European Heart Journal warns against underestimating the risk of rupture in asymptomatic patients with aortic aneurysms [1
The American College of Cardiology recommends considering earlier intervention in patients with connective tissue disorders 1
The European Heart Journal recommends avoiding calcium-channel blockers without beta-blockers in patients with aortic dissection, due to the risk of reflex tachycardia 3