Small aneurysms – These are less than 4 cm in diameter. Mostly in these cases wait and watch policy is adopted. Surgery is not advised because of the risk of surgery outweighs the risk of rupture. Routine serial ultrasound is done 6-12 monthly and the patient is warned that if he develops abdominal tenderness and backache (possible signs of dissection) he should report to the casualty immediately.
Medium aneurysms – these range between 4 – 5.3 cm diameter. In this case, there are no guidelines comparing the risk of surgery to rupture and so one has to discuss with his surgeon about the decision to leave alone or operate. If we decide to wait and watch then do an ultrasound every 6 months and note the growth rate of the aneurysm.
Large or fast-growing or leaking aneurysms – These are over 5.6 cm diameter or growing over 0.5 cm every 6 months. You will need surgery.
A leaking tender aneurysm is an emergency.