4.4 X 4.2 cm distal to the root is well below the "suggested" size for repair of 5.0 (sometimes even a bit Larger) I would ask you to consider a few things such as where is your Blood pressure typically ? (I know its going to go up and down depending on what your doing, so lets say sitting at rest what do you think it would be typically ? 120 or below /80 or below is good... are you diabetic or borderline? how about the cholesterol ? HDL (Good) should be HIGH LDL (bad) should be lower The Eliquis will help prevent the blood platelets from sticking (more the a "thinner" as we call them) which is a good thing ... also do you see him annually or Six month intervals? or less 3 months? just curious... One can worry oneself to death about these things too, I might be a little too outspoken as When MY Ascending Aorta Ruptured, at 1 am I lived literally 4 blocks from My Local Hospital/ER and 15 Minutes via ambulance From My state's Trauma Center a phone call from point to point had the Emergency Cardiac Team waiting for my Arrival because it was (is) a teaching hospital with experiences with AD's it all went quite well.. This is NOT always the case for everyone all over the planet of course often once your "diagnosed" you Might find yourself being Flown Via Helicopter to cut the time down as well

I would get a second opinion. An aneurysm is a serious problem. I worked for neurosurgeons for thirty three years.

a second opinion is always a good idea , & never hurt anyone.

Last years I totally 4 Stent from 75-100 Blocked 1 of them was 95% and other one was 100% I still shorten breath if do anything to much But I feel better then what I did. Also I had 5 bypass back in 2010 and also so I have a pacemaker back in 2014 and I'm also a diabetes ,Just keep a open mindeveryone is different and alway talk to your Dr.
God Bless you and Remember God is good all time. Jhon 3:16

Then Generally speaking One's aneurysm(s) should remain Smaller or the same as they have been The exception is one of the genetic Issues which you already mentioned You had No Known issues with... so It sounds Like your doing quite well then