The most appropriate management for this man with a 4.7-cm abdominal aortic aneurysm (AAA) is surveillance by abdominal ultrasonography every 6 to 12 months. Aneurysm diameter is the most important factor predisposing to rupture, with risk increasing with progressive increases in aneurysm size. For aneurysms smaller than 4.0 cm in diameter, the annual rupture risk is below 0.5%, whereas for aneurysms between 5.0 and 5.9 cm in diameter, the annual rupture risk is 3% to 15%. For AAAs with a maximum diameter less than 3.5 cm, repeat surveillance with ultrasonography may be repeated every 3 to 5 years. However, larger aneurysms require more frequent surveillance because of their tendency to expand faster than smaller aneurysms and their increased risk of rupture, with reevaluation on a 6- to 12-month basis recommended. Because this patient's aneurysm is 4.7 cm in diameter, he should undergo surveillance every 6 to 12 months.

Elective repair should be considered for AAAs of 5.5 cm in diameter in men and 5.0 cm in women, for AAAs that increase in diameter by more than 0.5 cm within a 6-month interval, and for those that are symptomatic (tenderness or abdominal or back pain).

AAA rupture has an exceedingly high mortality rate, and the risk of rupture is 0.5% to 5% annually for aneurysms between 4.0 cm and 4.9 cm in diameter. Therefore, no further management would not be appropriate in this patient with a 4.7-cm aneurysm.