A 72-year-old hypertensive smoker is found to have a 5.8 cm infrarenal abdominal aortic aneurysm (AAA) on surveillance ultrasound. He is high risk for open surgery due to severe COPD (FEV1 45%). The most appropriate management is:

• A Conservative management with repeat ultrasound in 1 year
• B Open surgical repair via transperitoneal approach
• C Fenestrated EVAR regardless of anatomy
• D Endovascular aneurysm repair (EVAR) if anatomically suitable ✓

Explanation

An AAA ≥5.5 cm (men) or ≥5.0 cm (women) with rapid expansion (>1 cm/year) warrants intervention. In a high surgical risk patient with COPD, EVAR is the preferred minimally invasive alternative, provided infrarenal anatomy is suitable (adequate neck length ≥15 mm, diameter ≤32 mm, neck angulation <60°). EVAR has lower 30-day mortality than open repair in high-risk patients. Conservative management is inappropriate for a 5.8 cm aneurysm. Fenestrated EVAR is for juxtarenal or suprarenal aneurysms.

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

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Written and medically reviewed by the StethoPrep medical team.