Q: 58 year old male admitted to ICU with acute Cholecystitis. CT scan of abdomen showed additional finding of infra-renal Abdominal Aortic Aneurysm with diameter of 5 cm. In asymptomatic patients, what is the usual cut-off point to consider surgical intervention in AAA? 

A) 4 cm

B) 4.5 cm

C) 5 cm

D) 5.5 cm

E)  6 cm

Answer: D

Though many factors effect the decision to consider surgical intervention in asymptomatic AAA like age, gender, rate of expansion and other associated co-morbidities but in general 2009 guidelines from the Society for Vascular Surgery recommends observation for asymptomatic AAA <5.5 cm in diameter. For female gender, a lower threshold of 5 cm is also recommended for elective repair of asymptomatic AAA as studies have shown higher rate of rupture in women compared with men for AAA of the same diameter.

Reference:

Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg 2009; 50:880.