NBME Step 2 CK Form 8 The aneurysm should not be repaired because of the patient’s poor prognosis (NBME Answers)

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submitted by ∗step_prep3(25)

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Elderly man with imaging showing metastatic pancreatic cancer also found to have a stable abdominal aortic aneurysm
Median survival of metastatic pancreatic cancer is 3-6 months, so the patient would most likely die from cancer before having any negative effects from the aneurysm, so repair of aneurysm has risks > benefits for this specific patient
Indications for abdominal aorta aneurysm repair in healthy patient: (1) > 5.5 cm in diameter (2) expansion of at least 0.5 cm in 6 months and/or 1 cm per year (3) symptomatic (abdominal pain, flank pain, limb ischemia)

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bobson150 It's frustrating that they'd expect us to know prognosis at this level. I know metastatic pancreatic cancer is bad news bears, but the AAA fits criteria for repair (in a healthy person) +13

ishockk Wait so if his aneurysm was symptomatic would you repair it? what are the clauses for (not) repairing? they should mention that in surgery fundamentals! +1

fuckyoudie this answer definitely seems like it could be argued. According to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076160/, the annual risk of rupture for an aneurysm of his size is 20-40%. Dying by exsanguinating into your own abdomen does not seem like a very pleasant way to die, and so it doesn't seem out of the question to fix his AAA to prevent that particular outcome, development of further symptoms. I could see this question becoming quickly out of date as chemotherapeutics for pancreatic cancer and AAA repair technology get better. +4