National Institute for Health and Care Excellence (NICE) has issued a new guideline on the diagnosis and management of abdominal aortic aneurysms (AAAs).
Several key recommendations were made in the guideline, the most important pertaining to the use of endovascular aneurysm repair (EVAR) within the NHS.
The draft guidance did not favour the use of EVAR. In response, the stakeholders argued that it would be challenging to quickly put into practice recommendations supporting open surgical repair over EVAR, where EVAR currently accounts for the majority of AAA repairs. The guideline now recommends considering EVAR in situations where open surgical repair cannot be performed due to some reasons, including medical or anaesthetic risks.
Justifying the recommendation, Paul Chrisp, director of the Centre for Guidelines at NICE, said: "We know that some clinicians prefer EVAR but what we are trying to do is steer the system to shift practice towards open surgery, in line with the evidence."
GPs should encourage all men aged ≥65 years to participate in the NHS AAA screening programme if they have not already. Routine screening is not offered to women, owing to a much lower risk than men. However, women aged ≥70 years may be considered for screening in the presence of risk factors such as hypertension, high cholesterol and smoking.
An abdominal aorta diameter of ≥5.5 cm warrants referral to a regional vascular service and patients to be seen within 2 weeks. Those with a diameter of 3.5-5.4 cm should be seen within 12 weeks.
The guideline also emphasises improving awareness of AAA among non-specialists by highlighting the signs, symptoms and risk factors indicative of symptomatic or ruptured AAA, which necessitates immediate ultrasound assessment. Earlier diagnosis of ruptured AAAs boosts the likelihood of appropriate treatment and survival.