Skip to textbook content
Doctor’s PassportTextbook
TopicsAll topics

Loading topic navigation…

Textbook navigation
TopicsAll topics

Loading topic navigation…
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Abdominal aortic aneurysm

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
!
Escalate

Sudden severe abdominal or back pain, collapse, hypotension or a tender/pulsatile abdominal mass may represent leaking or ruptured AAA: call the vascular team immediately, activate major-haemorrhage/resuscitation pathways and do not delay transfer for non-essential tests.

Synopsis

Recognise, measure and safely route abdominal aortic aneurysm in UK practice, including NHS screening, surveillance and repair thresholds.

  • AAA is an abdominal aortic diameter of 3.0 cm or more; most are asymptomatic until found by screening or incidental imaging.
  • In England, men are invited for one-off ultrasound in the screening year in which they turn 65; men older than 65 who have never been screened can self-refer.
  • Screening surveillance is annual for 3.0–4.4 cm and every 3 months for 4.5–5.4 cm aneurysms.
  • Refer an asymptomatic AAA of 5.5 cm or more to a regional vascular service, to be seen within 2 weeks.
  • NICE advises considering repair for a symptomatic AAA, an AAA at least 4.0 cm that grows by more than 1.0 cm in 1 year, or an asymptomatic AAA at least 5.5 cm.
  • A new painful or tender known AAA is an emergency even if the last diameter was below an elective threshold.
  • Ultrasound is the surveillance test; CT angiography is used for operative planning in people being evaluated for repair.
  • Smoking cessation, blood-pressure treatment and lipid/CVD risk management improve overall vascular prognosis, but no medicine substitutes for surveillance or indicated repair.

Key red flags

Symptomatic intact AAA

Persistent abdominal or back pain, focal tenderness or a new pulsatile sensation in a person with an AAA requires urgent vascular assessment.

Rupture or leak

Sudden severe abdominal/back/flank pain, syncope, pallor, shock or reduced consciousness; the classic triad is often incomplete.

Investigation priorities

01
Abdominal ultrasoundFirst step

Confirm and measure AAA without radiation or contrast.

Management branches

emergencySuspected ruptured or symptomatic AAA

Sudden severe abdominal/back pain, collapse, shock, tenderness or new pain over a known AAA.

  1. First: ABC resuscitation, two large-bore IV lines, bloods/crossmatch, analgesia and immediate senior vascular/anaesthetic contact.
  2. Next: arrange direct transfer to a vascular centre; use CTA only if sufficiently stable and it will change immediate operative planning.
  3. Escalation: activate major haemorrhage and proceed to endovascular or open repair according to anatomy, physiology and vascular-team judgement.
  4. Avoid excessive crystalloid or attempts to normalise blood pressure before haemorrhage control; use a patient-specific permissive-resuscitation strategy led by the emergency/vascular team.
Open full textbook →Answer 2 questionsCardiology check
Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG156: Abdominal aortic aneurysm—recommendationsDiagnosis, referral, repair criteria and treatment decision-making.
  • NHS: Abdominal aortic aneurysm screeningScreening eligibility, result bands and surveillance intervals.
  • GOV.UK: NHS AAA screening pathway requirementsCurrent England programme specification.
  • NHS: Abdominal aortic aneurysmPublic-facing symptom and emergency advice.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom