Fix at 5.0 cm or 5.5 cm? This is controversial among the experts.
This should be an individual decision. My understanding is that a female patient, who smokes, should probably have the surgery below 5.0 cm. The guideline was lowered from 5.5 to 5.0 at a conference in Fall 2022. Right after that a very well done study from Kaiser came out that suggested patients that are well managed (BP controlled, etc.) might be better off to wait until the aneurysm is 5.5.
This is not an easy surgery. Morbidity and mortality risks are NOT low. These statistics differ widely by centers. A patient would be well advised to have this surgery done at a center where they do a high volume of this procedure. Typically, centers that also do a reasonable volume of heart transplants may be a good choice/
There is also literature that indicates cooling the body is not enough. Mortality and neurological morbidity are significantly lower if the surgeon uses either antegrade or retrogade perfusion to the brain during surgery - and moderately cools the body.