AAA

Asymptomatic until symptomatic presentation (rupture/dissection) — no screening guidelines exist in Australia. Generally an incidental finding. More common in males who smoke.

Pattern: intense abdominal pain + pale and shocked ± back pain → ruptured AAA.

Risk factors

Smoking, family history, increased age.

Rupture risk by diameter

AAA diameter (cm)	Rupture risk (%/year)
3.0–3.9	0%
4.0–4.9	1%
5.0–5.9	1–10%
6.0–6.9	10–22%
>7.0	30–50%

RACGP AFP — Aortic aneurysms

Examination

Pulsatile abdominal mass.

Investigations

Ultrasound is first-line for screening; CT if clearer imaging is required (especially in obese patients). Targeted screening in at-risk groups should be considered in:

• Male patients aged > 65 with a smoking history.
• Patients aged > 65 with a primary relative history of AAA.
• Adults with a personal or primary relative history of Marfan, Loeys-Dietz, or similar syndromes.
• Patients with a known popliteal or thoracic aortic aneurysm.

There’s no dedicated MBS item for AAA screening — abdominal ultrasound is only rebatable as a diagnostic study with a clinical indication. Check MBS Online before quoting funding to patients.

Management

Optimise cardiovascular/medical risk factors (cease smoking, manage hypertension, diabetes, dyslipidaemia). Refer to a vascular surgeon for counselling, surveillance, treatment planning, and complex aneurysm decision-making.

Surveillance intervals (following ESVS):

AAA diameter (cm)	Surveillance interval (months)
3.0–3.9	24
4.0–4.5	12
4.6–5.0	6
>5.0	3

RACGP AFP — Aortic aneurysms

• Driving restrictions: conditional licence if AAA < 5cm.
• Screen for synchronous TAA or PAA, and suggest familial screening.
• Expedite surgical review if: unexplained abdominal pain/tenderness; rapid expansion (>1cm in 12 months); diameter close to the treatment threshold (5cm in women, 5.5cm in men).
• Treatment (open repair or EVAR) is determined by the vascular surgeon.
• Ruptured/symptomatic AAA: call an ambulance, notify the vascular surgeon, obtain IV access for fluids with permissive hypotension.