Management of small abdominal aortic aneurysms

Abdominal aortic aneurysm (AAA), a leading cause of death in older men, frequently poses a management problem for physicians. Although surgical repair of aneurysms over 6 cm is widely recommended, the issue of how best to manage small aneurysms is still being debated. Two strategies for managing AAA have been described: One is the immediate elective repair of all aneurysms (or all over 4 cm); and the other is the frequent follow-up with ultrasound, with surgery reserved for aneurysms that grow large or become symptomatic. Analysis of recent case series suggests that the total AAA-related mortality associated with the two strategies is similar. Randomized trials (including cost-effectiveness analyses) for comparing the two strategies are needed and are currently being planned. Meanwhile, the management of small AAAs must be individualized based on aneurysm size, local surgical experience, and the patient's surgical risk and preference.