Frimley Guidelines

AAA Patient Pathway

Abbreviations

CPXCardiopulmonary Exercise Test
CTACT Aorta
HRACHigh risk anaesthetic clinic
NAASPNational Aortic Aneurysm Screening Programme
OPAOutpatient appointment
POPSPerioperative Older People's Service
US(S)Ultrasound (scan)

Referral in from GP, incidental finding, other clinician or National Aortic Aneurysm Screening Programme.

AAA <5cm

  • Nurse surveillance

  • Optimization of cardiovascular risk factors

  • US abdominal aorta

  • 3 – 3.9 USS every 3 years

  • 3.9 – 4.9 – annual USS

  • If >5.1cm, refer to consultant

AAA 5.1cm or >

  • Refer to Vascular consultant

  • 5.1cm or greater: 6 monthly US abdominal aorta, until 5.5cm or > – FBC, U and Es, EGFR, BNP, G&S and Trop, CT whole aorta, +/- HbA1c

  • Refer to CPX, HRAC.

  • If unable to perform, consider POPS referral.

MDT discussion post CPX and CTA, must include consultants, anaesthetist, radiologists.

If other investigations required or referral to AHP, discuss at 2nd MDT, OPA.

Decision to treat

Complex endo, FEVAR/TEVAR treat within 12 weeks of diagnosis

  • Bloods

  • Images sent to manufacturer

  • Complex MDT

  • Consider referral to Cardiology, Renal - refer now if indicated.

  • Consider postop ICU- book bed

  • OPA with consultant

  • 30/7 CTA

  • 6/12 USS, plain film and bloods

Annual US Abdominal aorta

If an increase in sac size, or evidence of an endoleak at imaging, patient for MDT discussion.

Patient for further management / intervention

EVAR treat within 8 weeks of diagnosis

  • OPA with consultant

  • CPX request. Bloods including full blood count, urea creatinine, HbA1c, troponin BNP, Group & Save.

  • MDT - consider Renal, Cardiology referral if indicated.

  • CTA 30 days post op

  • USS at 6 months. Reimage CTA if increase in sac size.

Annual US Abdominal aorta

If an increase in sac size, or evidence of an endoleak at imaging, patient for MDT discussion.

Patient for further management / intervention

OPEN treat within 8 weeks of diagnosis

  • OPA with consultant

  • CPX, HRAC

  • MDT - consider Renal, Cardiology referral if indicated.

  • Book ICU bed

  • Pre-op assessment

  • Post Op OPA 6/52

  • Discharge from follow up.

BMT

  • OPA with consultant

  • Letter to GP

  • Discharge