MSFinals-6641

MSFinals-6641

An 78-year-old man with a history of diabetes, hypertension, hypercholesterolaemia, and previous myocardial infarction presents to his GP with intermittent abdominal pain for the past two months. The pain is dull and radiates to his lower back. During examination, a pulsatile expansile mass is found in the central abdomen. The patient had a previous US abdomen six months ago, which showed an abdominal aortic diameter of 5.1 cm. The GP repeats the US abdomen and refers the patient to the vascular clinic. The vascular surgeon reviews the patient’s US report, which shows no focal pancreatic, liver, or gallbladder disease, trace free fluid, an abdominal aorta diameter of 5.4 cm, no biliary duct dilation, and normal-sized and mildly echogenic kidneys. What aspect of the patient’s history indicates that surgery may be necessary?