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vasc.aaa.v1PRODUCTION
vasc.aaa.v1

Abdominal aortic aneurysm (surveillance + rupture)

vascularacutechronicadult
Hard-required inputs
0 / 6
Care setting:

Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Differentiate stable surveillance vs symptomatic / ruptured emergency (SVS 2024; ESVS 2019)

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Actions
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Advance rule
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phenotype assigned

Patient inputs (12)

Screening criteria + repair threshold + life expectancy (SVS 2024; ESVS 2019)

Repair threshold lower in women ~5.0 cm vs 5.5 cm (SVS 2024; ESC 2024)

Contrast planning; renal artery involvement (SVS 2024)

Definitive sizing + rupture/contained leak detection (SVS 2024; ESC 2024)

Permissive hypotension SBP 70-90 mmHg in suspected rupture (ESVS 2019)

Hemodynamic monitoring + tachycardia screen (SVS 2024)

Inflammatory / mycotic phenotype (ESVS 2019)

Mycotic AAA workup (ESVS 2019)

Strongest modifiable risk factor + smoking cessation (SVS 2024; ESVS 2019)

First-degree relative -> earlier screening (SVS 2024; ESVS 2019)

Marfan / EDS-vascular / Loeys-Dietz lower threshold (ESC 2024)

Screening + surveillance imaging (ESVS 2019; USPSTF 2019)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (6)

6 need judgement
  • informationallife_threateningrupture_or_symptomatic_intact
    Pain + known AAA OR triad of pain + hypotension + pulsatile mass (SVS 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningmycotic_aaa
    AAA + fever + elevated CRP + positive BC + FDG-PET avidity (SVS 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningsuspected_in_unstable_patient
    Known AAA + abdominal/back pain + hemodynamic instability (SVS 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevererapid_expansion
    AAA expansion >1 cm/year on serial imaging (SVS 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereconnective_tissue_low_threshold
    Marfan / Loeys-Dietz / vascular EDS with AAA (SVS 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderateendoleak_post_evar
    Sac expansion or persistent flow on post-EVAR imaging (SVS 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

Run this disease's risk and dosing calculators inline.

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Recommended regimen

AAA — surveillance + medical optimization + repair (ESVS 2024 / NICE NG156 / SVS 2018)
axis: aaa_phenotype_managementstep 1 - Step 1 — Surveillance for small AAA + medical risk-factor optimization
Selected step "Step 1 — Surveillance for small AAA + medical risk-factor optimization" — AAA 3.0–5.4 cm men / 3.0–4.9 cm women; asymptomatic
  • atorvastatin
    first line
    high_intensity_statin
    40-80 mg • PO • once daily
    triggers: AAA_with_concurrent_ASCVD_risk
    ESVS 2019; SVS 2024 — statin reduces CV mortality in AAA; pleiotropic effect on aneurysm growth uncertain
    rxcui 83367
  • aspirin
    first line
    antiplatelet_COX1
    81 mg • PO • once daily
    triggers: AAA_with_atherosclerotic_disease
    CV mortality benefit; not aneurysm-specific (SVS 2024; ESC 2024)
    rxcui 1191
  • lisinopril
    first line
    ACE_inhibitor
    10-40 mg • PO • once daily
    triggers: AAA_with_HTN
    BP control to <130/80 (SVS 2024); ACEi acceptable, no aneurysm-growth-specific evidence
    rxcui 29046
  • losartan
    first line
    ARB
    50-100 mg • PO • once daily
    triggers: ACEi_intolerant, connective_tissue_disorder
    Marfan benefit — COMPARE trial (Radonic EJCTS 2012); reasonable in CTD AAA (ESC 2024)
    rxcui 52175

outpatient playbook — drug actions (3)

  1. 1. high-intensity statin + ASA
    rxcui 83367
    Atorvastatin 40-80 + ASA 81 • PO • daily
    trigger: AAA + ASCVD-risk (SVS 2024)
    CV mortality benefit (SVS 2024; ESC 2024)
  2. 2. BP control to <130/80
    rxcui 29046
    Lisinopril 10-40 mg • PO • daily
    trigger: HTN (SVS 2024)
    Primary modifier (SVS 2024)
  3. 3. smoking cessation pharmacotherapy
    Varenicline / NRT / bupropion • PO/transdermal • per agent
    trigger: Active smoker (SVS 2024)
    Strongest modifiable risk factor (SVS 2024; ESVS 2019)

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Pulsatile abdominal mass on exam (SVS 2024); Abdominal/back pain + hypotension/syncope — rupture suspicion (ESVS 2019; SVS 2024); US/CT showing infrarenal aorta >=3.0 cm (SVS 2024; ESVS 2019).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Abdominal aortic aneurysm (surveillance + rupture)** (vasc.aaa.v1).
Phenotype framing: Infrarenal vs juxtarenal vs thoracoabdominal; saccular vs fusiform; mycotic vs inflammatory vs degenerative (SVS 2024; ESC 2024)
Scope: Differentiate stable surveillance vs symptomatic / ruptured emergency (SVS 2024; ESVS 2019)

No severity triggers fired against current inputs.

Plan

Regimen axis: **AAA — surveillance + medical optimization + repair (ESVS 2024 / NICE NG156 / SVS 2018)** — step "Step 1 — Surveillance for small AAA + medical risk-factor optimization".
1. atorvastatin 40-80 mg PO once daily (high_intensity_statin, first line) — ESVS 2019; SVS 2024 — statin reduces CV mortality in AAA; pleiotropic effect on aneurysm growth uncertain
2. aspirin 81 mg PO once daily (antiplatelet_COX1, first line) — CV mortality benefit; not aneurysm-specific (SVS 2024; ESC 2024)
3. lisinopril 10-40 mg PO once daily (ACE_inhibitor, first line) — BP control to <130/80 (SVS 2024); ACEi acceptable, no aneurysm-growth-specific evidence
4. losartan 50-100 mg PO once daily (ARB, first line) — Marfan benefit — COMPARE trial (Radonic EJCTS 2012); reasonable in CTD AAA (ESC 2024)

Setting playbook (outpatient) — Surveillance interval per size; aggressive risk-factor modification; refer for repair when threshold reached (SVS 2024)
5. high-intensity statin + ASA Atorvastatin 40-80 + ASA 81 PO daily — AAA + ASCVD-risk (SVS 2024) (CV mortality benefit (SVS 2024; ESC 2024))
6. BP control to <130/80 Lisinopril 10-40 mg PO daily — HTN (SVS 2024) (Primary modifier (SVS 2024))
7. smoking cessation pharmacotherapy Varenicline / NRT / bupropion PO/transdermal per agent — Active smoker (SVS 2024) (Strongest modifiable risk factor (SVS 2024; ESVS 2019))

Non-pharmacologic actions:
- Smoking cessation counselling (SVS 2024)
- Aerobic exercise (no maximal Valsalva) (SVS 2024)
- AAA-screen first-degree relatives age 65+ (SVS 2024)
- Vascular surgery referral when threshold reached (SVS 2024)

AVOID / contraindication checks:
- Beta_blocker_AVOID_acute_rupture_no_evidence_for_growth_reduction (SVS 2024)
- Permissive_hypotension_only_in_rupture (SVS 2024)
- Nephrotoxin_avoid_pre_imaging_with_contrast (SVS 2024)
- DAPT_post_EVAR_per_institutional_protocol (SVS 2024)

Monitoring

Regimen monitoring:
- aortic US q3 yrs for 3.0-3.9cm men (SVS 2024)
- aortic US q1 yr for 4.0-4.9cm men (SVS 2024)
- aortic US q3-6 mo for 4.5-5.4cm men (SVS 2024)
- CTA or duplex post EVAR at 1 6 12 mo then annually (SVS 2024)
- CRP + BC in inflammatory phenotype (SVS 2024)
- BP <130/80 (SVS 2024)
- lipid panel to LDL <70 (SVS 2024)

Setting (outpatient) monitoring:
- US per interval (SVS 2024)
- BP at each visit (SVS 2024)
- Lipid annually (SVS 2024)

Follow-up plan: Long-term smoking cessation; BP and statin optimization; family screening recommendations (SVS 2024; ESC 2024)
- Close-out criterion: long-term plan in place

Monitoring phase: Surveillance interval by size (ESVS 2019; SVS 2024); post-EVAR endoleak surveillance — CT/duplex 1, 6, 12 mo then annual (SVS 2024); post-open follow-up

Disposition

Current setting: outpatient — Surveillance interval per size; aggressive risk-factor modification; refer for repair when threshold reached (SVS 2024)

Disposition criteria:
- Stable surveillance → routine vascular clinic (SVS 2024)
- Threshold reached → repair referral (SVS 2024)

Escalation triggers (move to higher acuity):
- New abdominal/back pain → ED rupture rule-out (SVS 2024)
- Rapid expansion >1 cm/y → vascular surgery for early repair (SVS 2024)
- New connective tissue features → genetic / vascular consult (SVS 2024)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Pain + known AAA OR triad of pain + hypotension + pulsatile mass (SVS 2024)
- [LIFE_THREATENING] AAA + fever + elevated CRP + positive BC + FDG-PET avidity (SVS 2024)
- [LIFE_THREATENING] Known AAA + abdominal/back pain + hemodynamic instability (SVS 2024)

Citations

- ESVS 2024 (Wanhainen et al, Eur J Vasc Endovasc Surg 2024) + NICE NG156 + SVS 2018 + 2022 ACC/AHA Aortic + 2024 ESC PAD/Aortic [PMID:29766750](https://pubmed.ncbi.nlm.nih.gov/29766750/)
- Cited evidence (PMID 23900119) [PMID:23900119](https://pubmed.ncbi.nlm.nih.gov/23900119/)

Last reconciled with current guidelines: 2026-04-08.
References
  • ESVS 2024 (Wanhainen et al, Eur J Vasc Endovasc Surg 2024) + NICE NG156 + SVS 2018 + 2022 ACC/AHA Aortic + 2024 ESC PAD/Aortic — PMID:29766750
  • Cited evidence (PMID 23900119) — PMID:23900119