A 70-year-old hypertensive smoker has a 5.8 cm asymptomatic infrarenal abdominal aortic aneurysm (AAA). He is fit for intervention. The EVAR-1 trial and UK Small Aneurysm Trial established which threshold for elective AAA repair?
- A ≥4.0 cm (any gender)
- B ≥5.5 cm in men; ≥5.0 cm in women ✓
- C ≥6.0 cm (any gender)
- D ≥5.0 cm (any gender)
Correct answer: B. ≥5.5 cm in men; ≥5.0 cm in women
Explanation
UK Small Aneurysm Trial established that repair of AAA <5.5 cm in men did not improve survival over surveillance (rupture risk <1%/year), with elective repair threshold being ≥5.5 cm in men. For women, due to higher rupture risk at smaller diameters, the threshold is lower at ≥5.0 cm. EVAR-1 validated endovascular repair as an alternative to open repair, showing lower 30-day mortality for EVAR but equivalent long-term survival. Both open and EVAR are acceptable choices at the indicated threshold.
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.