Surgery is recommended in order to prevent an aortic catastrophes, including aortic rupture or aortic dissection. An aortic rupture is typically a fatal event. An aortic dissection is associated with a high rate of death as well as other serious complications including heart attack, stroke, and paralysis. The risk of these events increases with aortic size.
For aneurysms less than 5 cm, the risk of aortic catastrophe is approximately 4-6% per year. When the aneurysm grows to 5-6 cm, the annual risk increases to as much as 12% per year, and at 7cm it exceeds 25% per year. Given these risks, surgery is usually recommended for patients with aneurysms 5-5.5cm in diameter.
Once an aneurysm reaches 5 to 6 cm in diameter, the risk of rupture is very high. If rupture occurs, there is approximately an 80 to 95% chance of death. Therefore, the majority of vascular surgeons would agree that a 5 to 6 cm aneurysm should be repaired immediately, unless other medical factors make surgery risky.
Not all aneurisms require surgery, but the larger it grows, the more surgery becomes necessary.
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