This is a new guideline from NICE on investigating and managing AAA. It was published in Mar 2020. The main things for us are being aware of who we should be encouraging screening for.
Who should we be promoting screening to?
Screening is offered to all men in the year they turn 65.
Inform all men of 66 or more that screening for AAA is available and that they can self-refer. Details on how to self-refer can be found on the NHS website.
Encourage all men who are 66 or older to be screened if they have:
- coronary, cerebrovascular disease or peripheral vascular disease.
- family history of AAA.
- a history of smoking.
Consider screening women 70 or over if they have any of the above risk factors and if AAA hasn't already been excluded on imaging. Screening would be done with an USS.
What screening should you do and what do you do with the results?
- Offer aortic USS for screening.
- Offer aortic USS if an AAA is suspected on palpation.
How to act on the results:
- AAA 5.5cm or more - refer to be seen within 2 weeks.
- AAA 3 to 5.4cm - refer to be seen within 12 weeks.
How should we identify a symptomatic or ruptured AAA?
Beware new abdominal or back pain, CV collapse or loss of consciousness. Be aware that AAA is more likely if they:
- have an existing diagnosis of AAA.
- are age > 60.
- have a history of smoking.
- have a history of hypertension.
Be aware that AAA are more likely to rupture in women than in men.
Is there anything we need to do in the management of patients with AAA?
Family risk. We should advise patients that AAA can run in families and that they should tell their 'close relatives' that they may have an increased risk of AAA and may need assessment. Note there are a lot of 'mays' in there...
- Advise patients to stop smoking.
- Manage their hypertension.