Abdominal Aortic Aneurysm · Surveillance vs Open vs EVAR

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Rupture/symptoms? + diameter/growth
   Rupture/symptoms? Diameter and growth rate?
   • Rupture (severe pain + hypotension + pulsatile mass) or symptomatic (tenderness/abdominal-back pain) → Rupture/symptoms → emergency repair
   • Asymptomatic: men ≥5.5 cm or women ≥5.0 cm or growth >0.5 cm/6 months (>1 cm/year) → Threshold met · choose approach
   • Asymptomatic, below threshold → Below threshold → surveillance
2. [End] Rupture/symptoms → emergency repair
   Rupture or symptomatic → emergency: rupture needs immediate repair (emergency EVAR if anatomy suitable, otherwise open); permissive hypotension, rapid transfer to vascular surgery, cross-match.
3. [Decision] Threshold met · choose approach
   EVAR or open? (Repair threshold met (men ≥5.5, women ≥5.0 cm, rapid growth or symptoms).)
   • Endovascular repair EVAR (anatomy suitable: neck length/angulation/access) → Endovascular repair (EVAR)
   • Open repair (anatomy unsuitable for EVAR / young, long life expectancy) → Open repair
4. [End] Below threshold → surveillance
   Below threshold → imaging surveillance (4.0–4.9 cm every 12 months, 5.0–5.4 cm every 6 months, ultrasound/CT) + risk-factor control (smoking cessation, BP control, statin).
5. [End] Endovascular repair (EVAR)
   EVAR — low perioperative mortality, fast recovery; needs suitable anatomy (neck ≥10–15 mm, acceptable angulation, adequate access vessels) and lifelong surveillance (endoleak/reintervention).
6. [End] Open repair
   Open repair — more durable, suited to anatomy unfavorable for EVAR/young with long life expectancy; greater perioperative trauma and complications.

Source guidelines & references

• AAA management, SVS guideline (repair threshold 5.5 cm men / 5.0 cm women)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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