Table 3

Class I and Class IIa recommendations on maximal aortic diameter cut-off for treatment of aortic aneurysm in asymptomatic patients9

Ascending aortic aneurysm
 ≥55 mm▸ Patients with no aortopathy
▸ BAV without risk factors*
 ≥50 mm▸ BAV with risk factor*
▸ Marfan syndrome with no other risk factor†
 ≥45 mm▸ Marfan syndrome with risk factors†
▸ Patients with BAV undergoing surgical aortic valve repair
Aortic arch aneurysm
 ≥55 mmIsolated arch aneurysm (may be planned earlier if adjacent ascending or descending thoracic aortic aneurysm repair is planned)
Descending thoracic aortic aneurysm
 ≥55 mmIf anatomy is suitable for thoracic endovascular stent repair
 ≥60 mmSurgical repair, when anatomy is not suitable for stent repair
Abdominal aortic aneurysm
 ≥55 mmOpen/endovascular stent repair‡
  • *Coarctation of the aorta, systemic hypertension, family history of dissection or increase in aortic diameter >3 mm/year (measured at the same level)

  • †Family history of AD, aortic size increase >3 mm/year (measured at the same level), severe aortic or mitral regurgitation or desire for pregnancy.

  • ‡Also indicated if aneurysm growth >10 mm/year.

  • AD, aortic dissection; BAV, biscuspid aortic valve.