What specialist consultations should are needed for abdominal aortic aneurysm (AAA)?

Updated: Jan 08, 2019
  • Author: Saum A Rahimi, MD, FACS; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

The urgency of consultation is dictated by the stability of the patient. In patients who are stable and without symptoms, the diagnostic workup takes precedence. Consideration should be given to consulting a radiologist to determine whether ultrasonography, CT, or magnetic resonance imaging (MRI) would be the most appropriate study.

Follow-up with a vascular surgeon is warranted if the diameter of the abdominal aorta exceeds 3 cm or if the diameter of any segment of the aorta is more than 1.5 times the diameter of an adjacent segment.

Patients who have an AAA less than 4 cm in diameter require serial ultrasonography twice per year. If the diameter increases by more than 0.5 cm over 6 months or comes to exceed 4 cm, surgical repair usually is warranted.

For patients with an AAA who are symptomatic, immediate consultation with a surgeon is indicated. If the patient is hemodynamically stable, imaging modalities may be considered after discussion with the surgical consultant.

Immediate surgical consultation is also mandatory for cases involving unstable patients, followed by notification of anesthesia and operating room personnel. Bedside ultrasonography may be obtained while the patient awaits definitive treatment; however, it should not be allowed to delay surgery. CT is not appropriate in patients who are unstable.


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