A 72-year-old hypertensive man has an asymptomatic abdominal aortic aneurysm (AAA) with a maximum diameter of 5.6 cm detected on ultrasound. He is fit for intervention. The preferred treatment and its primary advantage over open repair is:

• A Open repair; lower long-term reintervention rate
• B EVAR (endovascular aneurysm repair); lower 30-day perioperative mortality ✓
• C EVAR; better long-term survival at 5 years compared to open repair
• D Active surveillance; <6 cm AAAs should be observed

Explanation

EVAR is the preferred first-line treatment for anatomically suitable AAAs ≥5.5 cm (men) or ≥5.0 cm (women) in fit patients, with a 30-day mortality of ~1.7% vs ~4.7% for open repair (EVAR-1 and DREAM trials). However, EVAR has a higher late reintervention rate (mainly for endoleaks) and the survival advantage disappears by 2 years; at 8 years, open repair has equivalent or slightly better survival (freedom from AAA-related death). Annual CT surveillance is mandatory after EVAR. Open repair remains appropriate for younger fit patients where durability is paramount.

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

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Written and medically reviewed by the StethoPrep medical team.