Synopsis
Recognise symptomatic or ruptured abdominal aortic aneurysm and coordinate immediate resuscitation, imaging, and vascular transfer.
- Treat new pain or collapse with suspected AAA as a vascular emergency.
- Contact the regional vascular service immediately; after acceptance, leave the referring unit within 30 minutes.
- Use restrictive resuscitation, prioritising blood components when needed; do not chase normal pressure before aortic control.
Key red flags
Sudden severe abdominal, flank or back pain with hypotension, syncope or collapse.
Known AAA with new persistent pain or abdominal tenderness, even below elective size thresholds.
A pulsatile abdominal mass with pain, shock or falling haemoglobin.
Unexplained collapse in an older current or former smoker, particularly with hypertension.
Failure to improve after repair, tense abdomen or oliguria suggesting abdominal compartment syndrome.
Abrupt abdominal, flank or back pain may be severe, persistent and accompanied by diaphoresis, nausea or a sense of collapse.
Tachycardia, hypotension, cool peripheries, confusion, syncope or oliguria indicate impaired perfusion from concealed bleeding.
Any new unexplained abdominal or back pain in a person with diagnosed AAA warrants immediate vascular discussion.
Preserved blood pressure does not exclude rupture because retroperitoneal tamponade can temporarily limit blood loss.
Rupture into the vena cava may cause high-output heart failure, a continuous abdominal bruit and leg venous congestion.
Investigation priorities
Identify an aneurysm during initial emergency assessment
Management branches
Suspected symptomatic or ruptured AAA in any acute setting
- Call the regional vascular service immediately while starting monitored ABC resuscitation.
- Secure large-bore intravenous access, send urgent bloods and activate major haemorrhage support when bleeding is likely.