Sitting in front of you is Mr. Evans, a 65 year old, very successful businessman, who also happens to be the biggest benefactor of your hospital. He had his annual checkup (compliments of the hospital) earlier today.

Although he says that he "feels in perfect health", you notice several important problems while perusing his records. He is a chronic smoker with a history of 40 pack-years.

His blood pressure is 124/82 mm Hg and heart rate is 76/min and regular. His pulses are of good volume, he has no bruits, and the results of his lung, heart, abdominal, and neurological examinations were unremarkable.

He was found to be dyslipidemic, with a total serum cholesterol of 240 mg/dL (6.2 mmol/L), HDL cholesterol of 40 mg/dL (1.0 mmol/L), and triglyceride level of 100 mg/dL (1.1 mmol/L). All other laboratory studies and an ECG were normal.

Last but not least, an ultrasound scan of the abdomen revealed a fusiform dilatation of the infrarenal abdominal aorta, with a 4.6 cm maximum diameter; this is compatible with an abdominal aortic aneurysm (AAA).

Mr. Evans awaits your opinion …