Patients with distal/peripheral aneurysms were older (35.5 [18 to 71] years vs. 30 [18 to 64] years; p = 0.04) and were more likely to have undergone prior aortic root replacement (Table 1). Distal disease was, however, present in approximately one-quarter of patients who had not had prior aortic root surgery and did not meet surgical criteria for such. Despite the greater likelihood of having had prior aortic replacement, the maximal attained aortic root diameter did not relate to the presence of distal disease. Although there was no difference between groups when assessing for the use of any antihypertensive agent, those patients with distal/peripheral aneurysms were less likely to be receiving an angiotensin-converting enzyme (ACE) inhibitor at the time of confirmatory MRA/CTA. There was no relationship between ACE inhibitor use and age, previous surgery, or other clinical variables. Patients with distal/peripheral aneurysms had a greater number of risk factors for acquired heart disease and were 14.9 times (95% CI: 1.75 to 127.21; p = 0.01) more likely to die than those without such aneurysms when controlling for smoking (odds ratio: 5.09 [95% CI: 1.07 to 24.31]; p= 0.04). After controlling for the presence of a distal/peripheral aneurysm, other variables (including age, family history of dissection, hypertension, hyperlipidemia, prior aortic surgery, and prior ascending aortic dissection) did not contribute to the model significantly and were removed. No patient died secondary to complications related to the ascending aorta. Treatments used for distal aneurysms varied according to aneurysm site. In general, aneurysms were observed serially, and if progressive in size, symptomatic, or if published surgical size criteria were met (2), surgical or percutaneous intervention was used. Of the 47 aneurysms noted, 26 (55%) required intervention.