A 65-year-old man is found to have an incidental 5.8 cm infrarenal abdominal aortic aneurysm (AAA). He is otherwise fit with no major comorbidities. According to current vascular surgery guidelines, what is the most appropriate management?

• A Repeat ultrasound surveillance in 12 months
• B Beta-blocker therapy and annual CT surveillance
• C Repair only if symptomatic
• D Elective endovascular aneurysm repair (EVAR) or open surgical repair ✓

Explanation

The UK Small Aneurysm Trial and ADAM trial established that elective repair is recommended for AAA ≥5.5 cm in men (≥5.0 cm in women) in fit patients, as the rupture risk (~25%/year at this size) outweighs operative mortality. Both EVAR and open repair are options; EVAR has lower short-term mortality but requires lifelong surveillance and has higher reintervention rates. Surveillance (6-monthly) is appropriate for 4.5-5.4 cm AAA. At 5.8 cm, repair is indicated.

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

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Written and medically reviewed by the StethoPrep medical team.