A 65-year-old man presents with a pulsatile, expansile, non-tender abdominal mass on routine examination. USS confirms an infrarenal abdominal aortic aneurysm of 6 cm diameter. He is otherwise asymptomatic. The best management is:
- A Elective endovascular aneurysm repair (EVAR) or open surgery ✓
- B Annual ultrasound surveillance
- C Antihypertensive therapy and 6-monthly ultrasound
- D Emergency laparotomy
Correct answer: A. Elective endovascular aneurysm repair (EVAR) or open surgery
Explanation
An abdominal aortic aneurysm (AAA) of 5.5 cm or more in men, or 5.0 cm in women, meets the threshold for elective repair due to significant rupture risk exceeding operative mortality. At 6 cm, the annual rupture risk is approximately 10-20%. EVAR is preferred in anatomically suitable patients due to lower perioperative mortality; open repair is used when EVAR is not anatomically feasible. Surveillance is reserved for aneurysms below 5.5 cm.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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