A 68-year-old hypertensive smoker is found on CT to have an infrarenal abdominal aortic aneurysm (AAA) measuring 5.6 cm in maximum diameter. He is otherwise fit. According to UK Small Aneurysm Trial and ESVS 2019 guidelines, the appropriate management is:

• A Surveillance scan in 6 months
• B Medical therapy with beta-blockers and statins only
• C Proceed only if the aneurysm exceeds 6.5 cm
• D Endovascular aneurysm repair (EVAR) or open repair ✓

Explanation

ESVS 2019 and NICE guidelines recommend elective repair for AAA ≥ 5.5 cm in men (≥ 5.0 cm in women) or if rapid expansion > 1 cm/year. At 5.6 cm in a fit patient, intervention is indicated. EVAR is preferred in high-risk surgical patients; open repair is equally durable in low-risk patients. Medical therapy alone does not prevent rupture above threshold diameter. Surveillance is appropriate only below the 5.5 cm threshold.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.