Recommendations for Aortic Arch Aneurysms

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	Recommendations
1	C-EO	1. In patients with an aortic arch aneurysm who have symptoms attributable to the aneurysm and are at low or intermediate operative risk, open surgical replacement is recommended.
2a	B-NR	2. In patients with an isolated aortic arch aneurysm who are asymptomatic and have a low operative risk, open surgical replacement at an arch diameter of ≥5.5 cm is reasonable.1–3
2a	C-LD	3. In patients undergoing open surgical repair of an ascending aortic aneurysm, if the aneurysmal disease extends into the proximal aortic arch, it is reasonable to extend the repair with a hemiarch replacement.4,5
2b	C-LD	4. In patients undergoing open surgical repair of an aortic arch aneurysm, if the aneurysmal disease extends into the proximal descending thoracic aorta, an elephant trunk procedure may be considered.6,7
2b	C-EO	5. In patients with an aortic arch aneurysm who are asymptomatic but meet criteria for intervention, but have a high risk from open surgical repair, a hybrid or endovascular approach may be reasonable.