ABSTRACT
Surgery, Baylor College of Medicine, and Cardiovascular Surgery Service, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas, U.S.A.
INTRODUCTION
Progressive aortic dilatation and rupture are the inevitable consequences of untreated aortic aneurysms and dissections. The only treatments that effectively eliminate the risk of aortic rupture are surgical replacement of the diseased aortic segment with a graft and intraluminal exclusion of the segment with an endovascular stent graft. Because of the associated risks, aortic repair procedures are performed only in patients who are at significant risk of aortic rupture. The decision of when to repair an aneurysm is based primarily on the severity of aneurysmal disease-as indicated by symptoms, aortic diameter, and aortic expansion rate-in the context of other factors that increase the likelihood of rupture, such as connective tissue disorders or a family history of ruptured aneurysm. Patients who have not reached the clinical threshold for aortic repair receive nonoperative treatment and careful surveillance with imaging studies.
