REMEDY : BNSSG referral pathways

Abdominal Aortic Aneurysm (AAA)

Checked: 24-01-2018 by Rob.Adams Next Review: 22-01-2019

Screening Program

An abdominal aortic aneurysm (AAA) is defined as an enlargement of the aorta of 3cm or greater in diameter ( NICE (February 2009). Endovascular stent-grafts for the treatment of abdominal aortic aneurysms. )

The national AAA screening program for England invites men to have screening in the year that they turn 65.  Men older than 65 who have not been screened can also self-refer into the screening program.  Please refer to the AAA Information Sheet (PDF). 

Men who have an AAA identified via the screening program will be monitored within the program or referred directly to a vascular clinic if appropriate. 

For patients (men and women) who fall outside of this screening group but who have a suspected or confirmed AAA then please see sections below. 

 

Asymptomatic AAA

Patients who are diagnosed with asymptomatic AAA incidentally (outside of screening program) or via a GP led investigation should be referred to the local vascular clinic (see referral section below). These patients cannot be referred into the screening program.

Local vascular surgeons advise the following management depending on size of the aneurysm:

Patients with asymptomatic AAA smaller than 5.5 cm should be referred to the Vascular Clinical Nurse Specialist (CNS) clinics we run across the network (refer routinely via eRS). This means that these patients receive a similar standard of care to patients with screen detected aneurysms. The CNS will talk to them about the diagnosis, look for other arterial disease and provide advice on exercise, lifestyle and cardiovascular risk reduction. The patient will be entered into surveillance under a named vascular surgeon. If their AAA grows to 5.5 cm they will be seen by the surgeon within 2 weeks to discuss repair. Some patients will have a second CNS review at 5.0 cm when surveillance moves to 3 monthly. This service is available via eRS and can be processed by Bristol Referral Service.

Patients with asymptomatic AAA 5.5 cm or greater should be referred urgently via eRS to Vascular HOT clinic. We will triage these referrals and aim for an appointment within 2 weeks or next day for AAA over 7cm.’

 

PLEASE NOTE  THAT CURRENTLY VASCULAR HOT CLINIC CANNOT BE ACCESSED FROM PRIMARY CARE AND REFERRALS SHOULD BE MARKED URGENT. THEY WILL THEN BE REVIEWED IN SECONDARY CARE AND BOOKED INTO A HOT CLINIC IF APPROPRIATE.

Referral

Referrals for asymptomatic AAA < 5.5cm:

Refer routinely via eRS requesting vascular clinical nurse specialist clinic.

Referrals for asymptomatic AAA >= 5.5cm

Refer urgently to the Vascular HOT Clinic  at NBT which is now available via eRS (do not send via Referral Service to avoid any potential delays). Patients with AAA between 5.5 to 7cm will be triaged to clinic slots within 2 weeks. Patients with AAA greater than 7cm will be seen on the next working day.

Please also see the Vascular services - For clinicians page on the NBT website for further information.

Red Flags

Patients with an asymptomatic but rapidly expanding AAA (>5mm over 6 months) should he referred urgently to the vascular HOT clinic via eRS (see above).

All patients with suspected symptomatic AAA should be discussed  immediately via the on call vascular team at NBT.

If a ruptured AAA is suspected (classic triade of hypotension, abdominal pain or back pain and a pulsatile abdominal mass) then call 999 and liaise with on call vascular team at NBT.