Aortic Aneurysm Referral Guidelines

Introduction to Referral Criteria

The American College of Cardiology recommends that asymptomatic patients with degenerative thoracic aneurysm should be referred for surgical evaluation when the ascending aorta or aortic sinus diameter reaches 5.5 cm or greater 1, 2
Patients with genetic disorders like Marfan syndrome should be referred for surgery at smaller diameters (4.0-5.0 cm) 1
The American College of Cardiology suggests that patients with Loeys-Dietz syndrome should be referred when aortic diameter reaches 4.2 cm or greater by transesophageal echocardiogram or 4.4-4.6 cm by CT/MRI 2

The American Heart Association recommends that patients with a growth rate of more than 0.5 cm/year in an aorta less than 5.5 cm in diameter should be referred for surgical evaluation 1, 2
Patients with confirmed growth rate ≥0.3 cm/year in 2 consecutive years, or ≥0.5 cm in 1 year should be referred for surgery, as per the American College of Cardiology guidelines 3
The American College of Cardiology states that patients with symptoms suggestive of expansion of a thoracic aneurysm should be referred for prompt surgical intervention 1, 2

The European Society of Cardiology recommends that men with AAA ≥5.5 cm in diameter should be referred for vascular surgery evaluation 5
Women with AAA ≥5.0 cm in diameter should be referred for vascular surgery evaluation due to their four-fold higher rupture risk at the same AAA diameter compared to men, as suggested by the European Heart Journal [5, 4 is excluded in favor of 5]
Rapid growth of AAA (≥5 mm in 6 months or ≥10 mm per year) warrants vascular surgery referral regardless of absolute size, according to the European Heart Journal 5

The American College of Cardiology recommends that for isolated aortic arch aneurysms less than 4.0 cm in diameter, imaging should be repeated every 12 months 6
For isolated aortic arch aneurysms 4.0 cm or greater in diameter, imaging should be repeated every 6 months, as per the American College of Cardiology guidelines 6
The European Heart Journal suggests that AAA 3.0-3.9 cm should be surveilled with ultrasound every 3 years 5

The American College of Cardiology states that patients undergoing aortic valve repair/replacement with a concomitant ascending aortic aneurysm ≥4.5 cm should be referred for ascending aortic replacement 3, 1
Patients with a height >1 standard deviation above or below the mean who have an asymptomatic aneurysm with a maximal cross-sectional aortic area/height ratio of ≥10 cm²/m should be considered for surgery, as per the American College of Cardiology guidelines 3