Abdominal Aortic Aneurysm

Refer to Vascular Surgeons

Who to refer:

• Patients with a finding of abdominal aortic aneurysm (AAA – an aorta with a diameter ≥3cm). Typically patients should have a confirmed AAA on imaging but in cases where a large expansile/ pulsatile mass is palpable referral should not be delayed
• Men under the age of 65 and women of any age with a strong family history of aneurysm disease who are seeking or have been advised to undergo screening: that advice is often given by vascular units and applies particularly to sons or brothers of those developing large AAAs at a young age.
• Men over the age of 65 can self refer to the AAA screening service (see below).
• Patients with a confirmed AAA who experience abdominal/back/loin pain or tenderness on palpation of the aneurysm or have evidence of distal embolisation – Such patients should be discussed directly with the Vascular Surgery Registrar on-call at the Royal Infirmary of Edinburgh (available 24 hours/day via switchboard) and emergency transport to A&E – NOT the vascular ward – at the Royal Infirmary of Edinburgh arranged. These patients will be assessed by the Vascular Surgery team on arrival in A&E.
• Patients without a confirmed AAA where a ruptured or symptomatic AAA is a differential diagnosis – Such patients should also be discussed with the Vascular Surgery Registrar and emergency transport to A&E NOT the vascular ward at the Royal Infirmary of Edinburgh arranged. These patients will be assessed by the A&E team and if appropriate referred onto the vascular service.

Who not to refer to the Vascular Surgeons but rather the AAA screening service

•  Men over 65 who are not known to have a confirmed AAA can self refer for a one off AAA screening ultrasound through our national aneurysm screening programme

The AAA Screening Service can be contacted on 0131 242 3606

More information can be found at:https://www.nhsinform.scot/healthy-living/screening/abdominal-aortic-aneurysm-aaa/abdominal-aortic-aneurysm-aaa-screening

How to refer:

SCI Gateway (Basic SIGN Referral) for asymptomatic aneurysms

• Asymptomatic aneurysms should be referred via Sci-Gateway (RIE > Vascular Surgery > Basic Sign Referral). AAA greater than 5cm should be marked as urgent AAA .

• Patients with a confirmed AAA who experience abdominal/back/loin pain or tenderness on palpation of the aneurysm or evidence of distal embolisation.Such patients should be discussed directly with the Vascular Surgery Registrar on-call at the Royal Infirmary of Edinburgh (available 24 hours/day via switchboard) and emergency transport to A&E – NOT the vascular ward – at the Royal Infirmary of Edinburgh
• Patients without a confirmed AAA where a ruptured or symptomatic AAA is a differential diagnosis   Such patients should also be discussed with the Vascular Surgery Registrar and emergency transport to A&E NOT the vascular ward at the Royal Infirmary of Edinburgh arranged. These patients will be assessed by the A&E team and if appropriate referred onto the vascular service

Information to include in referral:

• Description of how AAA was detected (ie palpation/imaging modality)
• Maximum AP diameter (Small: 3cm-4.4cm, Medium: 4.5cm-5.4cm, Large 5.5cm+)
• Presence or absence of cardiovascular risk factors, and how these have been addressed
• Co-morbidities
• Functional and Cognitive status

Best Medical Therapy to institute with referral

• Smoking cessation
• Antiplatelet agent (Aspirin first line)
• Statin therapy
• Exclude / manage hypertension
• Exclude / manage diabetes

​Best Medical Therapy to institute with referral

• Smoking cessation
• Antiplatelet agent (Aspirin first line)
• Statin therapy
• Exclude / manage hypertension
• Exclude / manage diabetes