Aortic aneurysms Screening, surveillance and referral

Background Aortic aneurysms are a common finding in elderly patients. Rupture of an aortic aneurysm is a catastrophic event associated with a very high mortality. Objective To review the current literature on aortic aneurysmal disease, including the recommended referral threshold, surveillance guidelines and treatment options. Discussion Screening of men aged 65 years and over has been shown to reduce aneurysm related mortality, however, no formal screening guidelines exist in Australia. In addition to the risk of aneurysm expansion and rupture, patients are at increased risk of cardiovascular morbidity and mortality. Small aneurysms should be managed with surveillance and cardiovascular risk factor modification. Large aneurysms should be referred promptly to a vascular surgeon for assessment and repair. Symptomatic and ruptured aneurysms require emergency assessment and treatment. Advances in endovascular techniques enable most patients with aortic aneurysms to be treated with minimally invasive stent grafts, which have lower perioperative complication rates than open repair.