When should an abdominal aortic aneurysm be repaired?

For patients who are not fit for general anaesthesia, there is a lot of discussion going on as to whether they should be offered an endovascular aneurysm repair if they are not suitable for open repair from a medical or anaesthetic point of view. It should be considered that But it is now known from the national screening data that the rupture rate of somebody with a 5.4cm aneurysm is only 0.4% per annum. Therefore when considering as to whether you should intervene in a patient who is generally medically unwell and to repair their aneurysm, a lot of consideration should be given as to their quality of life, their life expectancy and to the risk of intervention and their risk of rupture and it is certainly probable that in the past we have overestimated the risk of rupture. There has been good evidence to suggest that certainly in the more elderly patients that you could probably not use the 5.5 centimetre trigger but you could happily go up to a 6 centimetre trigger. It has also been evidenced following the fact that within the Covid crisis there has been a suggestion by various societies that you could actually wait till the diameter became seven centimeters and this was a threshold that was used during the crisis and further work is required to actually re-look at what is the appropriate time to recommend intervention. This is certainly an important area that is being researched in the moment. So the important thing I would say to you as as a patient is to try and get from your clinician what they think is the actual risk of rupture and what is the risk of you undergoing an intervention. Thank you very much.