A 70-year-old hypertensive male smoker is found to have a 5.6 cm fusiform abdominal aortic aneurysm (AAA) on routine ultrasound. He is asymptomatic. According to UK Small Aneurysm Trial and current guidelines, the appropriate management is:
- A Urgent surgical repair as any AAA >5 cm requires emergency intervention
- B Annual ultrasound surveillance without repair until symptoms develop
- C Percutaneous balloon angioplasty to reduce aneurysm sac pressure
- D Elective repair (open or EVAR) as the aneurysm exceeds the threshold of 5.5 cm beyond which rupture risk outweighs operative risk ✓
Explanation
The UK Small Aneurysm Trial demonstrated that for AAAs 4–5.5 cm, early surgical repair offers no survival benefit over surveillance. The threshold for elective repair is a maximum diameter ≥5.5 cm in men (≥5.0 cm in women by some guidelines), because beyond this the annual rupture risk (~10–25%) exceeds the operative mortality of elective repair (~2–5%). At 5.6 cm, this patient meets the repair threshold. Repair options include open surgical repair or EVAR (endovascular aneurysm repair), with EVAR preferred for anatomically suitable patients. Balloon angioplasty has no role in AAA management.
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.