Mean growth rates for ascending and aortic arch aneurysms range from 0.2 to 2.8 mm/y, while those for descending and TAAs range from 1.9 to 3.4 mm/y. Accelerated TAA growth is associated with large aneurysm size, distal aneurysm locations, Marfan syndrome, BAV, chronic aortic dissection, and COPD. The goal of medical therapy in TAA disease is to reduce aneurysm growth rates, the risk of aortic (dissection or rupture) and nonaortic cardiovascular events, and the need for aortic repair. However, evidence for such practices remains limited. Lifestyle modifications include smoking cessation and avoidance of intense isometric exercises, as well as collision sports, to avoid increases in systolic blood pressure that pose a risk for aortic growth and rupture.

Pharmacotherapy for the treatment of aortic disease includes the use of select antihypertensive agents, such as β-blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs), to mitigate medial degeneration and reduce aortic wall stress, as well as statins to modulate inflammatory and atherosclerotic pathways. There are class I recommendations for treatment with either a β-blocker or an ARB in patients with MFS; class II recommendations exist for patients with LDS and sporadic or degenerative TAA disease. There is insufficient data to recommend pharmacotherapy in vEDS. The American College of Cardiology Joint Committee (ACC) and American Heart Association (AHA) recommended targets of systolic blood pressure (SBP) less than 130 mm Hg and/or diastolic blood pressure (DBP) less than 80 mm Hg in patients with cardiovascular disease, although the optimal threshold in patients with TAA has not been evaluated in randomized clinical trials. It is also reasonable to administer low-dose aspirin to patients with atherosclerotic TAA and concomitant aortic atheroma.

References

• Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al; Peer Review Committee Members. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146:e334-e482.
• Oladokun D, Patterson BO, Sobocinski J, et al. Systematic review of the growth rates and influencing factors in thoracic aortic aneurysms. Eur J Vasc Endovasc Surg. 2016;51:674-681.
• Sharples L, Sastry P, Freeman C, et al. Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: the effective treatments for thoracic aortic aneurysms study. Eur Heart J. 2022;43:2356-2369.