I survived a sudden complete dissection Type-A1 Ascending Arch Aneurysm at 50 years old. I would have gladly given my left arm to have avoiding emergency surgery. For a federal litigator like me, it was a total personal/medical/financial/professional/emotional disaster. Moreover, if I knew then what I know now, I would have the planned surgery 100 times out of 100. It's safer. It's better. You are basically asking whether you should keep doing 75MPH on the freeway, when you have gotten an alert of your dashboard that says your front left tire is about blow out. Do you pull over and change it before disaster strikes (planned surgery) or do you speed up and wait for the inevitable (emergency surgery)? I did not have the option since I did not have a clue what an aorta even was when mine blew out on a business trip to San Diego in 2015. If you knew now, what I know now, you would not even pose the question--you'd have the EVAR procedure. Don't ignore this. It's fatal. Here's my complete analysis:

You have an abdominal aortic aneurysm, which is a ballooning or enlargement of the aorta, the large blood vessel that runs through your abdomen. Yours has grown to 6.7 cm, which is quite large.

What is EVAR?
EVAR stands for Endovascular Aneurysm Repair. It is a minimally invasive surgery where we use a small incision to insert a stent-graft (a tube covered with fabric) into the aorta to reinforce the weakened section and prevent it from rupturing.

Pros and Cons of Having Surgery Now
Pros:
Prevent Rupture: The biggest advantage is preventing the aneurysm from rupturing, which can be life-threatening.
Less Invasive: EVAR is less invasive than open surgery, meaning a shorter recovery time, less pain, and fewer complications.
Lower Risk of Complications: Acting now lowers the risk of the aneurysm bursting unexpectedly, which can be catastrophic.
Cons:
Surgery Risks: As with any surgery, there are risks such as infection, bleeding, or complications from anesthesia.
Need for Future Monitoring: After EVAR, you will need regular check-ups to ensure the stent-graft stays in place and functions correctly.
Waiting Until the Aneurysm Dissects
Pros:
Avoid Immediate Surgery: You avoid the immediate risks and recovery process associated with surgery.
Cons:
High Risk of Rupture: At 6.7 cm, the risk of the aneurysm rupturing is significant, which can be fatal or lead to severe complications.
Emergency Surgery: If it dissects (tears), emergency surgery will be required. This type of surgery has higher risks and complications compared to planned surgery.
Limited Options: In an emergency, EVAR might not be an option. You might need open surgery, which is more invasive, has a longer recovery period, and carries higher risks.
Will EVAR Be Possible if There is a Dissection?
If the aneurysm dissects, the situation becomes much more complicated. The structure of the aorta will be severely damaged, and it might not be suitable for EVAR. In many cases, emergency open surgery is required instead, which is more risky and demanding on your body.

Conclusion
Given the size of your aneurysm, having the EVAR procedure now can significantly reduce the risk of rupture and the associated severe complications. Waiting until the aneurysm dissects can lead to a more dangerous and complicated emergency situation, potentially making EVAR not feasible and necessitating a more invasive surgery with higher risks.

It's important to weigh these factors carefully and discuss them with your healthcare provider to make an informed decision.