What are the current guidelines for the management of abdominal aortic aneurysms in primary care, including referral criteria?

Management of abdominal aortic aneurysms (AAA) in primary care involves:

• Offering an aortic ultrasound to people with a suspected AAA on abdominal palpation, and referring those with an AAA of 5.5 cm or larger to a regional vascular service within 2 weeks, and those with an AAA measuring 3.0 to 5.4 cm to be seen within 12 weeks ¹.
• Identifying people at risk, such as men aged 66 or over, and encouraging self-referral to the NHS AAA screening programme, especially if they have risk factors like smoking, hypertension, or family history ¹.
• Considering an ultrasound for women aged 70 and over with risk factors if AAA has not been excluded ¹.
• In cases of symptomatic or suspected ruptured AAA, offering immediate bedside ultrasound and discussing with a regional vascular service if an AAA is confirmed or suspected ¹.
• Monitoring asymptomatic AAAs with ultrasound surveillance at intervals similar to the NHS screening programme ¹.
• Referral to a vascular service is recommended for AAAs ≥5.5 cm or those that have grown more than 1 cm in a year, with shared decision-making about repair options based on individual health status and aneurysm size ¹.
• Considering open surgical repair for suitable unruptured AAAs, and EVAR (endovascular aneurysm repair) for those with specific co-morbidities or anatomical considerations, after discussing benefits and risks with the patient ¹.

Referral criteria include:

• AAA ≥5.5 cm in diameter ¹.
• AAA that has grown by more than 1 cm in 1 year ¹.
• Symptomatic AAA or suspected rupture, requiring urgent assessment and transfer ¹.