A-Z
Topics
Latest

Abdominal aortic aneurysm

About

What is covered

This NICE Pathway covers diagnosing and managing abdominal aortic aneurysms. It aims to improve care by helping people who are at risk to get tested, specifying how often to monitor asymptomatic aneurysms, and identifying when aneurysm repair is needed and which procedure will work best.

Updates

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on diagnosing and managing abdominal aortic aneurysm in an interactive flowchart

What is covered

This NICE Pathway covers diagnosing and managing abdominal aortic aneurysms. It aims to improve care by helping people who are at risk to get tested, specifying how often to monitor asymptomatic aneurysms, and identifying when aneurysm repair is needed and which procedure will work best.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Laparoscopic repair of abdominal aortic aneurysm (2007) NICE interventional procedures guidance 229
Stent-graft placement in abdominal aortic aneurysm (2006) NICE interventional procedures guidance 163

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Standard and complex EVAR

Standard EVAR is defined as any EVAR procedure:
  • using a standard infrarenal device (an unmodified off-the-shelf stent graft) and
  • following the manufacturer's 'instructions for use' for the device used and
  • without any adjunctive procedures (planned use of endo-anchors and planned permanent instrumentation of aortic branch vessels, such as 'chimney' or 'snorkel' procedures).
Any EVAR procedure that does not fit into the definition above is classed as 'complex EVAR'. Complex EVAR also covers fenestrated, branched, customised or internal iliac branch devices, and physician-modified stent grafts.

Endoleak

The persistence of blood flow outside an endovascular stent–graft but within the aneurysm sac in which the graft is placed. There are 5 types of endoleak:
  • Type 1 – blood flowing into the aneurysm because of an incomplete or ineffective seal at either end of a stent-graft
  • Type 2 – blood flowing into an AAA from small side branches of the aorta
  • Type 3 – blood flowing into an AAA through defects in the endograft
  • Type 4 – blood flowing through the stent-graft fabric into an AAA
  • Type 5 – continued AAA expansion without radiographic evidence of a leak site.

Endoleak

The persistence of blood flow outside an endovascular stent-graft but within the aneurysm sac in which the graft is placed. There are 5 types of endoleak:
  • Type 1 – blood flowing into the aneurysm because of an incomplete or ineffective seal at either end of a stent-graft
  • Type 2 – blood flowing into an AAA from small side branches of the aorta
  • Type 3 – blood flowing into an AAA through defects in the endograft
  • Type 4 – blood flowing through the stent-graft fabric into an AAA
  • Type 5 – continued AAA expansion without radiographic evidence of a leak site.
When measuring aortic size with ultrasound, report the inner-to-inner maximum anterior-posterior aortic diameter, in accordance with the NHS AAA screening programme. Clearly document any additional measurements taken.
For guidance on care of people with a ruptured AAA for whom repair is considered inappropriate, see the NICE Pathway on caring for an adult at the end of life.

Glossary

abdominal aortic aneurysm
abdominal aortic aneurysms
estimated glomerular filtration rate
endovascular aneurysm repair
chronic obstructive pulmonary disease
(an abdomen that is difficult to perform open surgery within, because of adverse anatomical features: for AAA repair, these features can include large abdominal wall defects or intra-abdominal adhesions; a hostile abdomen is most common in people who have had multiple previous episodes of intra-abdominal open surgery)
(an AAA arising below the arteries that supply the kidneys)
(a method of fluid administration that aims to reduce bleeding by keeping a person's blood pressure within a lower-than-normal range)
Physiological and Operative Severity Score for enUmeration of Mortality
Vascular Biochemical and Haematological Outcome Model
Vascular Governance North West

Paths in this pathway

Pathway created: March 2020 Last updated: March 2020

© NICE 2020. All rights reserved. Subject to Notice of rights.

Recently viewed