A 72-year-old hypertensive male has a 5.8 cm infrarenal abdominal aortic aneurysm (AAA) discovered incidentally. He is fit for intervention. According to current guidelines (ESVS/SVS), what is the preferred intervention?
- A Endovascular aneurysm repair (EVAR) if anatomy is suitable; open repair if unsuitable ✓
- B Open surgical repair is preferred for all infrarenal AAA >5.5 cm
- C Continued surveillance until 6 cm before intervention
- D EVAR is contraindicated in patients >70 years
Explanation
Current ESVS 2019 guidelines recommend intervention for infrarenal AAA ≥5.5 cm in males (≥5.0 cm in females) or rapid expansion (>1 cm/year). EVAR is preferred for anatomically suitable aneurysms (adequate infrarenal neck length ≥15 mm, neck angulation <60°, adequate iliac access) as it has lower perioperative mortality (EVAR-1, DREAM, OVER trials) compared with open repair, although long-term survival is equivalent due to aneurysm-related late complications requiring reintervention. Open repair remains indicated for unsuitable EVAR anatomy, connective tissue disorders (Marfan, Ehlers-Danlos), or young fit patients in whom lifelong EVAR surveillance is burdensome.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.