Elective surgical repair is recommended for Aneurysms > 5 cm in women and > 5.5 cm in men (when risk of rupture increases to > 5 to 10% / year), unless coexisting medical conditions contraindicate surgery Additional indications for elective surgery include Increase in aneurysm size by > 0.5 cm within 6 months, regardless of size Chronic abdominal pain Thromboembolic complications Iliac or femoral artery aneurysm that causes lower-limb ischemia Aneurysms > 4.5 cm in patients with Marfan syndrome Before elective repair, clinical consideration of coronary artery disease (CAD) is often needed and may or may not require further evaluation (see table Tests for Assessing Cardiac Anatomy and Function) because some patients with an abdominal aortic aneurysm have significant risk of cardiovascular events.