A 72-year-old ex-smoker with hypertension and hypercholesterolaemia presents with a pulsatile abdominal mass. B-mode ultrasound shows a focal fusiform dilatation of the infrarenal aorta. The structure marked **A** in the diagram measures 5.5 cm outer-wall to outer-wall in true cross-section. Based on this measurement and the clinical presentation, what is the most appropriate next step in management?

Question

Accepted Answer

A. Refer urgently for CT angiography and vascular surgery evaluation for consideration of elective endovascular repair. The infrarenal aortic diameter marked **A** at 5.5 cm meets the threshold for intervention according to the Society for Vascular Surgery 2018 Practice Guidelines on AAA. A maximum diameter of ≥5.5 cm in a patient with good functional status and no contraindications warrants urgent referral for CT angiography and vascular surgery evaluation to discuss elective endovascular aneurysm repair (EVAR) with appropriate landing zones. The patient is asymptomatic apart from vague discomfort (no acute symptoms like back pain or syncope), making elective intervention appropriate rather than emergency surgery. Surveillance imaging is inadequate at this threshold diameter, and anticoagulation alone does not address the mechanical risk of rupture. The measurement of outer-wall to outer-wall diameter in true cross-section perpendicular to the long axis is the standard method for AAA sizing and determines intervention thresholds.

Answer

B. Reassure the patient and arrange surveillance ultrasound in 6 months, as the aorta is still within normal limits

Answer

C. Initiate immediate open surgical repair without further imaging, given the symptomatic presentation

Answer

D. Commence anticoagulation therapy and arrange follow-up imaging in 3 months to assess for progression

Explanation

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