A 70-year-old hypertensive smoker is found to have an incidental 5.8 cm infrarenal abdominal aortic aneurysm (AAA) on ultrasound. He is otherwise fit. According to ESVS guidelines, the preferred repair strategy is:
- A Endovascular aneurysm repair (EVAR) if anatomy is suitable ✓
- B Surveillance ultrasonography every 6 months
- C Open surgical repair
- D CT angiography followed by decision after 1 year
Correct answer: A. Endovascular aneurysm repair (EVAR) if anatomy is suitable
Explanation
For elective AAA repair, the threshold is ≥5.5 cm in men (≥5.0 cm in women). At 5.8 cm, elective repair is indicated. EVAR is preferred over open repair for anatomically suitable patients (adequate proximal neck, no severe angulation) as it has lower 30-day mortality (1% vs 3–5%), though long-term outcomes require surveillance for endoleak. The EVAR-1 trial confirmed equivalent long-term all-cause mortality compared to open repair by 10 years.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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