Asymptomatic Patient

As soon as aortic pathology is detected, the clinician has to determine what relevant management should follow. If the patient is asymptomatic, and it is likely that the finding is co-incidental, no immediate action may be needed. In this instance, the aorta is likely to measure >5 cm.

Be very cautious in deeming an aneurysm, co-incidental in the context of an Emergency Department Presentation. If truly asymptomatic/an incidental finding, suggest outpatient formal US on discharge.

Symptomatic Patient

In the case of a symptomatic aneurysm, there may be either rapid expansion or rupture and the scan will not determine which. The clinical setting is all-important and urgent vascular surgery consultation should be arranged. Two good venous access lines should be established, and at least six units of blood should be cross matched the massive transfusion protocol activated as required. A CT will always be the preferred next investigation where possible.


Some patients will have indicated their wishes for no repair in the event of rupture. This decision may have been made some time before, and a record may have been placed in the patient’s notes. It is not rare, however, for such intentions to be revoked when the emergency actually develops, so always talk this through with the patient and next of kin where possible.

Assuming resuscitation takes place, most clinicians aim for hypotensive resuscitation.  Rupture is an indication for traditional surgery, whereas electively some cases are suitable for endovascular aneurysm repair.  This is usually best for smaller aneurysms <5.5cm.

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