Mount Carmel Health Partners Clinical Guidelines Abdominal Aortic Aneurysm
Abdominal Aortic Aneurysm
Clinical Guideline
Definition: An abdominal aortic aneurysm (AAA) is an enlargement of the lower part of the aorta that extends through the abdominal area (at
times, the upper portion of the aorta in the chest can be enlarged). The aorta is the main blood vessel that carries blood from the heart to the rest
of the body. Like most arteries, the aorta is elastic, which allows it to be filled with blood under high pressure. An aneurysm develops when the
wall of the artery becomes weakened and distended like a balloon.
No
AAA
suspected; are
symptoms
present?
Yes
Asymptomatic AAA
Based on history
and physical
Evaluate for key symptoms:
• back, flank, abdominal, leg, groin, scrotal pain
• signs of aortic fistula
• flank ecchymosis
Evaluate for alternative symptoms: syncope, focal
neurologic deficit (especially lower extremities),
weakness, dizziness, GI bleed with anemia, anuria,
or signs of limb ischemia
Based on incidental imaging
(spine MRI, US, CT, x-rays)
Abdominal US
imaging of choice
Manage according
to risk of rupture
(see Table Three)
Risk factor assessment (see Table One)
Is
imaging
adequate at defining
extent of aneurysm and
maximum diameter
including iliac
arteries?
Pre-notify vascular surgeon
Yes
Order abdominal and
pelvic CT angiogram
Is the patient
hemodynamically
unstable (SBP less
than 100)?
No
No
Yes
Order abdominal and
pelvic CT angiogram
Physical exam suggests
aneurysm and/or focused
bedside ultrasound suggests
aneurysm
Manage according to
risk of rupture
(see Table Three)
No
Is
aneurysm
known?
Yes
Is
AAA
present?
Yes
Prepare and transfer
to endovascular suite
No
Consider alternative diagnosis
December 2015