I am at 4.5 cm, AAA was identified 3 years ago at 4.0. From my experience and ones of others in this forum and without going into long details you should try to be referred to a thoracic surgeon who actually does these operations. They are normally affiliated with major hospitals which have the resources to do this kind of surgery if needed and give the right kind of advice on how to avoid a problem in the meantime. In my case they require a CT scan each year and some times also an eco. They consider surgery at 5.0 cm. the rate of increase apparently might require surgery earlier. But again best that you connect with the right specialist who will guide you on best way forward. Lots of good info in this forum.

I went to the ER For what felt like was a Heart attack in the early part of 2020. When they did a CT, they found the aneurysm. A very kind doctor after several hours came in to ask if I knew I had an ascending aortic aneurysm. No, I did not. This same doctor is now my thoracic surgeon. My ascending aortic aneurysm, which is on the arch of my aorta is also at 4.1. In the same hospital visit, it was determined that I had high blood pressure. I was told to find a cardiologist and after a lot of searching, I found one. I was put on blood pressure medication. Thankfully, these doctors are both in the same office and work closely together. They communicate on all of my issues around both. Every year since then I have had a follow up CT to see if there is any growth in my aneurysm. It’s coming up at the end of this month and I’m hoping it’s the same. It has not grown at all in four years and my doctor told me that it could have been there for many years and I never knew it. After that statement, and because it hasn’t changed in four years, I try not to worry or even think about it. Hearing it at first was a little bit of a blow, but I never feel anything and try not to worry about it. I was prescribed medications to make sure I stay heart healthy. I don’t love taking statins, but they seem to be keeping things in line and I take the smallest dose there is. I’m 72 now and blood pressure meds were probably inevitable, but those are also low-dose. I also was told not to lift anything over 30 pounds… Must be standard. Try not to worry, as impossible as that sounds. Yours may be the same. You could’ve had it for 20 years and never known it. Just make sure you protect it and do as you’re told to do this. If you’re not comfortable with your thoracic surgeon, find another one if possible. You are going to only see them once A year usually. I see the cardiologist every six months and he shares information. My doctor even had to tell me not to ride any crazy amusement park rides. Not a problem! 😂 good luck!!

As others have commented, your body size, the rate of growth, family history, other ailments you may have, shape of the aneurysm, etc all are taken into account when they decide to operate (also physical fitness of course to support surgery). But the key is to have the right team advising you, and the ideal is to have a cardilogist who specialiazes in aneurysms and a thoracic surgeon that communicate with each other (as @carolinlv commented below). It makes a huge difference, that was my case 5 years ago when they discovered mine after a bike accident, mine was already 5.2 cm so surgery followed soon after, but the care, responses and support I received from my Drs was incredible and made everything so much easier. I still see my cardiologist every year, I get an Echo (they monitor my Aortic valve as it is bicuspid and will need replacement at some point), but also every 4 years he orders a complete body scan to make sure other aneurysms are not appearing.

Best of luck to you!!

My mom is also 5ft 1. She has a dialated ascending aorta of 4.1 that was discovered in 2020. She has been monitored and hers is stable at 4.1 and has not grown. She is 75 years old now. There is a calculator on line that calculates the upper limit of normal by age as
Diameter = Age x .16 + 31
For my mom that would mean 43mm or 4.3 cm is the upper limit of normal for her. Her cardiologist said this aneurysm is not on his list of things to worry about at her age. She is 5 ft 1. Exercises an hour each day (cycling, walking) she is a healthy weight. She is trying to control her high cholesterol (hereditary) and slight elevated blood pressure. (Sometimes it’s normal sometimes mildly elevated. Dr. Put her on a child size dose of metoprolol which seems to be helping) there are also charts online that quantify risk of rupture based on height and stature. The consensus is that you are correct, height and stature should factor in to accessing what size to operate. I am 52 and 5 ft 5 and just found out about my own dialated ascending aorta of 3.9 cm a few weeks ago. My sister is 53 and found out about her ascending aorta at 4.3 cm last December. My mother’s father died of a ruptured brain aneurysm at 65 years old. He had a stroke 10 years prior. No one else on either side of my family has aneurysms to our knowledge and my mom has four brothers and her mother who is 97 years old and doing well. Does this constitute a family history? I have no idea.. still trying to figure all this out for my family. Wishing you good health!