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Abdominal Aortic Aneurysm Repair — EECC MCQ

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ModerateAortic DiseaseAbdominal Aortic Aneurysm RepairEECC

A 70-year-old man with a 6.5 cm infrarenal abdominal aortic aneurysm is assessed for repair. He has significant comorbidities (COPD, eGFR 30 mL/min/1.73 m²) and CT shows suitable anatomy for endovascular repair. What is the preferred approach?

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Correct answer: C — Endovascular aneurysm repair (EVAR) given the high surgical risk and suitable anatomy

Abdominal aortic aneurysms ≥55 mm in men (or ≥50 mm in women, or growing >10 mm/year) require repair. In patients with suitable anatomy and high surgical risk (significant comorbidities), EVAR is preferred over open repair due to lower perioperative mortality (EVAR-1, DREAM trials). However, EVAR requires lifelong surveillance for endoleaks and sac expansion (annual CT or ultrasound). Open repair may be preferred in younger, fit patients due to superior long-term durability. CKD is a relative consideration for contrast exposure during EVAR but does not contraindicate the procedure. At 6.5 cm, this aneurysm is well above the intervention threshold and conservative management alone would be inappropriate.

Reference: ESC (2024): Guidelines for the Management of Peripheral Arterial and Aortic Diseases; NICE AAA Screening Guidelines