A 72-year-old man with a 40 pack-year smoking history presents for routine imaging. Abdominal ultrasound reveals a focal aortic dilatation measuring 5.8 cm in maximum diameter in the infrarenal segment, as marked **B** in the diagram. The patient is asymptomatic with stable vital signs. Which of the following is the most appropriate next step in management?
A. Immediate emergency surgical intervention
B. Ultrasound surveillance every 6 months
C. Elective endovascular or open aortic repair
D. CT angiography for anatomic assessment and surgical planning
Explanation
Why Elective endovascular or open aortic repair is right
The structure marked B represents an abdominal aortic aneurysm (AAA) measuring 5.8 cm in maximum diameter. According to SVS Practice Guidelines and USPSTF criteria, elective repair is indicated when the maximum aortic diameter reaches ≥5.5 cm in men or ≥5.0 cm in women. This patient's aneurysm exceeds the threshold for elective repair. The next step is not surveillance but definitive intervention—either endovascular aneurysm repair (EVAR, the predominant modality in ~80% of elective cases) or open surgical repair. CT angiography will be performed as part of preoperative planning, but the management decision itself is repair, not continued observation.
Why each distractor is wrong
Ultrasound surveillance every 6 months: This interval is appropriate for AAAs measuring 5.0–5.4 cm in men, which are below the repair threshold. At 5.8 cm, this patient has already crossed into the repair-indicated range and continued surveillance alone would be inappropriate and expose the patient to unnecessary rupture risk.
CT angiography for anatomic assessment and surgical planning: While CT angiography is essential for surgical planning, it is a preparatory step after the decision to repair has been made. The question asks for the most appropriate next step in management, which is the decision to proceed with repair itself, not the imaging that follows that decision.
Immediate emergency surgical intervention: Emergency repair is reserved for symptomatic or ruptured AAA. This patient is asymptomatic with stable hemodynamics, making elective (planned) repair the appropriate approach. Emergency intervention would be unnecessarily morbid and carries higher operative mortality than elective repair.
High-YieldNEET PG
AAA ≥5.5 cm in men (≥5.0 cm in women) = repair threshold; smaller aneurysms undergo size-based surveillance intervals; symptomatic or ruptured AAA = emergency intervention.
SVS Practice Guidelines on AAA 2018; USPSTF AAA Screening 2019; Sabiston 21e
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