• Patients with abdominal aortic aneurysms require regular surveillance as evidence has shown there is an increased risk of rupture once they reach 6cms in diameter (U.K Small Aneurysm study (1998) At Frimley Health, therefore, surgery is usually offered at 5.5cm, if the aneurysm is symptomatic, or enlarges rapidly >1 cm per year.

• Patients whose aneurysms are over 5cms on diagnosis are referred directly to consultant clinic.

• Patients who have undergone Endovascular Aneurysm Repair require continued post operative surveillance by vascular scientist, to monitor for reduction in aneurysm sac size and detection of any endoleak, graft migration or occlusion.

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Abbreviations

This service is led by the vascular clinical nurse specialists. Within the clinic, an Ultrasound scan of the abdomen is performed. Measurements should be recorded in ‘Anterior Posterior view’.

It is important images are reproducible so should be clearly recorded if inner-to-inner or outer-to-outer measurements are utilised. Ideally, both measurements will be documented.

Men should be considered for imaging surveillance using ultrasound, every three years for abdominal aortic aneurysms 30mm - 39mm in diameter, annually for aneurysms, 40mm - 49mm, and every six months for aneurysms at 50mm, taking into account life expectancy, suitability for future repair, and patient preferences.

Women should be considered for imaging surveillance using ultrasound, every three years for abdominal aortic aneurysms 30mm - 39mm in diameter, annually for aneurysms 40mm - 44mm, and every six months for aneurysms at 45mm, taking into account life expectancy, suitability for future repair, and patient preferences (see ESVS2024).

Any new referral to the vascular service may be referred directly to the nurse led clinic, and will then be given a repeat ultrasound scan and correct scanning intervals determined.

Any discrepancy in sizing of the aneurysm will be referred to the vascular laboratory for confirmation of size.

Risk factor modification

All patients with an abdominal aortic aneurysm should receive cardiovascular risk factor management with smoking cessation, blood pressure control, statin (Atorvastatin 80mgs) and antiplatelet (Aspirin 75mgs) therapy, and lifestyle advice (including exercise and healthy eating).

First degree relatives, at 55 years old need to be advised of familial history of aneurysms, and age-appropriate screening advised. If normal ultrasound scan at 55, should still be encouraged to attend NAAASP surveillance at 65.

Any male patients which may present with an aneurysm over 5cms should be referred for consultant follow up. Any female patients which present with an aneurysm over 4.5cm should be referred for consultant follow up.

The Vascular Consultant will refer for CPX and CT imaging when aneurysm reaches appropriate size. The patients will then be discussed at MDT with a consultant anaesthetist present.

Should a patient present to nurse led clinic with aneurysm over 5.5cm, arranging a CTA and CPX should be considered.

Discontinuing Follow up

Any patients who wish to discontinue surveillance of their AAA, either pre-operatively or post-operatively will be discussed at the MDT with outcome clearly documented on electronic patient records and their General Practitioner notified.

Any patients who are considered not suitable for intervention will also be discussed at Vascular MDT and entered onto the ‘turndown registry’ held on the Vascular audit drive. The GP will be notified.

Wanhainen, A. (2024) The 2024 ESVS AAA guidelines. Available at: ESVS-2024-AAA-GL_11zon.pdf (Accessed: 24 October 2024).

Wanhainen, A. et al. (2024) ‘European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms’, European Journal of Vascular and Endovascular Surgery, 67, pp. 192-331. Available at: Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms (Accessed: 24 October 2024).

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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