@scottbliz I would be in a big rush to ensure that the 4.7 measurement is accurate. These are not the easiest thing to measure, and if you have someone doing it who doesn't do it often you can get operator error as well. If the measurements are accurate- going from 4.1 to 4.7 in one year coupled with your family history would suggest that you need surgery right now. You need to be seen at a hospital that has a high volume of aortic aneurysm surgeries. I'd be very surprised if there are any hospitals in west Texas that fit that criteria.
I'm guessing Houston or Dallas might have good options. I am working with both Cleveland Clinic and Mayo. If the time comes for me to need surgery, (likely) I want to compare the surgical experience of the specific surgeons each place is recommending- and see if they have the same recommendation on how to fix it. From what I know, we have a very low risk if we have elective surgery at a high volume hospital with an experienced surgeon to fix this- but face extremely high mortality risk if it becomes an emergency repair issue.