A 68-year-old woman is found to have a 5.8 cm infra-renal abdominal aortic aneurysm (AAA) on ultrasound surveillance. She is cardiovascularly fit with no significant comorbidities. CT angiography confirms an infra-renal AAA with a 15 mm neck below the renal arteries, without significant angulation or iliac involvement. What is the recommended treatment?

• A Open surgical repair (elective)
• B Conservative surveillance with USS in 6 months
• C Statin therapy and blood pressure control alone
• D Endovascular aortic aneurysm repair (EVAR) ✓

Explanation

For an asymptomatic AAA of 5.8 cm (above the 5.5 cm threshold for intervention in women) with suitable anatomy (adequate infra-renal neck ≥15 mm, acceptable angulation), EVAR is the first-line intervention due to lower perioperative mortality, less physiological insult, and faster recovery compared to open repair, though long-term re-intervention rates are higher with EVAR and lifelong surveillance is required. Surgery is recommended above 5.5 cm in women (and 5.5 cm in men) because rupture risk outweighs operative risk. Open surgical repair is an equally valid alternative in anatomically suitable, fit patients but carries higher perioperative morbidity. Surveillance alone is inappropriate above the treatment threshold.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.