Indications for Repair of the Aneurysmal Aorta

Aneurysmal dilation is one of the primary pathologies necessitating surgical intervention on the ascending aorta. Aortic aneurysms are largely asymptomatic. As such, knowledge of the natural history and risks associated with surgical intervention are critical. Surgical replacement is indicated when the risk of spontaneous rupture or dissection surpasses the risk of significant complications associated with surgical intervention. Maximum diameter is the major predictor of complications for aortic aneurysm. The presence of a connective tissue disorder is a modifier of this effect. For the purposes of this article, we will discuss aneurysms of the aorta proximal to the brachiocephalic artery. Indications for patients with and without connective tissue disorder will be discussed separately.