A 72-year-old woman presents with a tender, pulsatile, 6.5-cm abdominal aortic aneurysm. She is on warfarin for atrial fibrillation. Which of the following is an absolute indication for surgery for AAA?
- A Any symptomatic AAA (tender, new back pain, rapidly expanding) ✓
- B Diameter ≥5.5 cm in women
- C Diameter ≥5.0 cm in women with hypertension
- D AAA diameter >4 cm with COPD
Correct answer: A. Any symptomatic AAA (tender, new back pain, rapidly expanding)
Explanation
Any symptomatic AAA — whether tender, causing new back or abdominal pain, or showing rapid expansion (>1 cm/year or >0.5 cm in 6 months) — is an absolute indication for urgent repair regardless of size, because these features indicate impending rupture or contained rupture. Elective repair thresholds are diameter ≥5.5 cm in men and ≥5.0 cm in women (NICE/SVS guidelines), reflecting lower threshold for women due to higher rupture risk per unit size. This patient's tenderness is an absolute indication for immediate repair.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.