Sports medicine specialists have a unique opportunity to identify individuals who may be at risk for thoracic aortic disease. These patients may have physical features such as tall stature and long limbs (which typify Marfan syndrome), but also lend themselves to participation in competitive athletics. These individuals are at increased risk of sudden death from aortic dissection. Avoiding or delaying aortic complications involves recognition and screening, medications, and prophylactic surgery when the aorta reaches a size threshold. A key feature in management is recognition of the aortic disease and avoiding those sports or exercises that place excess strain or stress on the aorta. Care involves multiple disciplines including primary care physicians, cardiologists, geneticists, ophthalmologists, and orthopedic and cardiac surgeons; however, the sports medicine specialist is often instrumental in guiding the athlete toward proper diagnosis and safe activities in an effort to avoid catastrophic complications.