A 70-year-old man with a known 5.2 cm infrarenal abdominal aortic aneurysm (AAA) is being monitored. The UKSAT and ADAM trials established which diameter threshold for elective AAA repair in men to achieve a mortality benefit?

• A ≥4.5 cm diameter
• B ≥6.0 cm diameter
• C ≥4.0 cm diameter in any patient
• D ≥5.5 cm diameter ✓

Explanation

Both the UKSAT (UK Small Aneurysm Trial) and the ADAM (Aneurysm Detection and Management) trial conclusively showed that early repair of AAA below 5.5 cm does not improve survival compared to ultrasound surveillance, as the operative mortality risk exceeds the rupture risk for smaller aneurysms. The current guideline threshold for elective repair in men is ≥5.5 cm, while in women (who have higher rupture risk) the threshold is lower (≥5.0 cm). EVAR (endovascular aortic repair) versus open repair depends on anatomical suitability.

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

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