Treatment of Unruptured Thoracic Aortic Aneurysm When Medical Therapy Does Not Achieve Blood Pressure Goals

Clinical Scenario

This protocol applies to patients with an unruptured thoracic aortic aneurysm (TAA) who have received antihypertensive medical therapy but have not achieved the target blood pressure — a systolic of ≤130 mm Hg and a diastolic of ≤80 mm Hg. When those goals are not reached, escalation to a structured repair approach is considered.

Previous line — goals not achieved

Prior therapy: Risk-factor modification and antihypertensive medical therapy

Goals not achieved: Systolic blood pressure ≤130 mm Hg and diastolic blood pressure ≤80 mm Hg

Next step — repair: The escalated approach involves surgical or endovascular aneurysm repair, with the specific method determined by aneurysm location and anatomical suitability. Complete repair criteria, selection of repair type, and the full procedural algorithm are contained in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/CIR.0000000000001106

In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have a maximum diameter of ≥5.5 cm, surgery is indicated.
In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have a maximum diameter of ≥5.0 cm, surgery is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.
In patients with an aneurysm isolated to the ascending aorta who meet criteria for surgery, aneurysm resection and replacement with an interposition graft should be performed.
In patients undergoing aortic root replacement with an aortic valve that is unsuitable for sparing or repair, a mechanical or biological valved conduit aortic root replacement is indicated.
In patients undergoing aortic root replacement, valve-sparing aortic root replacement is reasonable if the aortic valve is suitable for sparing or repair and when performed by experienced surgeons in a Multidisciplinary Aortic Team.
In patients with intact descending TAA, repair is recommended when the diameter is ≥5.5 cm.
In patients without Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome, who have a descending TAA that meets criteria for intervention and anatomy suitable for endovascular repair, TEVAR is recommended over open surgery.

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