A 72-year-old hypertensive man is found to have a 5.8 cm infrarenal abdominal aortic aneurysm (AAA) on surveillance ultrasound. He is otherwise fit. What is the MOST appropriate management?

• A Continue surveillance ultrasound every 12 months
• B Emergency repair is needed due to high rupture risk
• C Medical management with beta-blockers and repeat imaging in 6 months
• D Elective repair — either open or endovascular (EVAR) ✓

Explanation

The threshold for elective AAA repair is ≥5.5 cm in men (≥5.0 cm in women) or growth rate >1 cm/year, based on trials showing rupture risk exceeds operative mortality at these sizes. At 5.8 cm, this patient meets the criteria for elective repair. Both open surgery and EVAR are acceptable; EVAR has lower 30-day mortality but similar long-term outcomes with the need for ongoing surveillance and reintervention. Surveillance alone is appropriate for <5.5 cm aneurysms.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.