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The Joint Council of the American Association of Vascular Surgeons (JCAAVS) recommends that for the "average" person with a small aneurysm, when the size of the aneurysm reaches 4.5 - 5.5 cm (or 4.5 - 5.0 cm. for women), the decision regarding elective surgery is dependent on patient preference. Studies have repeatedly shown that the long term results of early surgery are equivalent to those of surveillance and later surgery. Thus the patient must decide whether early surgery will improve their quality of life or whether they are committed to adhering to regularly scheduled appointments for ongoing observation of aneurysm diameter.

Although in the ADAM and USAT studies approximately 60% of the patients in the surveillance group had to undergo AAA repair within 5 years, their mortality rates were not significantly different than those of the group that opted for early repair. However, it is clear from the studies that ongoing, consistent surveillance is crucial in order to prevent rupture due to rapid expansion and to minimize symptoms.

Ultrasound scanning is the standard for current clinical management of ongoing surveillance of aneurysm size for patients with an abdominal aortic aneurysm. Based on the outcomes of the ADAM and USAT studies, the following guidelines have been generally adapted:

• Elective surgical repair of AAA is recommended for AAA associated with symptoms, rapid growth, or size equal to or larger than 5.5 centimeters.

• For small AAAs (less than 5.5 centimeters), surveillance by abdominal ultrasound scanning is a safe option with recommended surveillance intervals (for the average AAA) as follows:

  • 4.0 to 4.9 centimeters: every 6 months
  • 5.0 to 5.4 centimeters: every 3 months

Intervals for ongoing assessment of an abdominal aortic aneurysm may vary according to the particular circumstances of an individual.

Non-compliance is a significant problem for those patients who choose surveillance of their aneurysm since they usually do not feel ill and, therefore, tend to minimize the need for strict adherence for regularly scheduled evaluation.

If other factors are present, (e.g. hypertension, chronic obstructive pulmonary disease - COPD, a family history of aneurysm) the advantages and disadvantages of surveillance vs. early intervention must be carefully weighed. For these individuals who are at higher risk of rupture, some clinicians feel that 5.5 cm. is too high a threshold for intervention.