A 72-year-old male presents with a painless pulsatile abdominal mass noted on physical examination. Abdominal ultrasonography reveals an infrarenal abdominal aortic diameter of 5.8 cm. What is the standard management recommendation?

Answer and explanation

Correct answer: A. Elective surgical repair (open or endovascular aneurysm repair - EVAR)

  1. Step 1: Assess aneurysm dimensions: An abdominal aortic aneurysm (AAA) with a diameter in men (or in women) has an exponentially higher annual risk of rupture (up to 10% per year).
  2. Step 2: Identify clinical indication: Threshold for elective intervention is 5.5 cm.
  3. Step 3: Select therapy: Elective repair (EVAR or open surgical grafting) is recommended to prevent catastrophic fatal rupture.
Answer
Elective surgical repair (open or endovascular aneurysm repair - EVAR).
Why not the others: 'Observation with repeat ultrasound' is appropriate for aneurysms ; 'Anticoagulants' do not halt aneurysmal dilation and increase bleeding risk; 'Emergency bedside laparotomy' is reserved for unstable rupturing aneurysms, not asymptomatic intact ones.

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