A 72-year-old man with a 6.2 cm infra-renal abdominal aortic aneurysm (AAA) is evaluated for intervention. He has a history of COPD with FEV1 of 45% predicted and creatinine of 160 μmol/L. CTA shows an aneurysm neck of 2.5 cm length, neck angulation of 35°, and bilateral common iliac artery dilatation to 20 mm. The most appropriate intervention and rationale is:
- A Open surgical repair (OSR) because endovascular anatomy is unsuitable
- B Conservative management with surveillance ultrasound every 6 months
- C Endovascular aortic repair (EVAR) using standard bifurcated device — EVAR is preferred for patients with significant comorbidities with suitable anatomy ✓
- D Fenestrated EVAR (FEVAR) due to short aneurysm neck
Explanation
At 6.2 cm, this AAA exceeds the 5.5 cm threshold for repair in men (EVAR-1 and DREAM trials). The patient's significant comorbidities (severe COPD, impaired renal function) make him a high surgical-risk candidate, where EVAR offers lower 30-day mortality than OSR (1.2% vs 3.7% in EVAR-1). The neck length of 2.5 cm (standard requirement ≥1.5 cm), angulation of 35° (<60° for most devices), and iliac landing zones make him suitable for standard EVAR. Fenestrated EVAR is reserved for short necks (<15 mm) or juxtarenal aneurysms. EVAR patients require lifelong CT surveillance for endoleak.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.