Inform all men aged 66 or over who have not already been screened about the NHS abdominal aortic aneurysm (AAA) screening programme, and advise them that they can self-refer.

Encourage men aged 66 or over to self-refer to the NHS AAA screening programme if they have not already been screened and they have any of the following risk factors:

Consider an aortic ultrasound for women aged 70 and over if AAA has not already been excluded on abdominal imaging and they have any of the following risk factors:

Be aware that people of European family origin are at a higher risk of an AAA.

Offer an aortic ultrasound to people in whom a diagnosis of asymptomatic AAA is being considered if they are not already in the NHS screening programme.

Offer an aortic ultrasound to people with a suspected AAA on abdominal palpation.

Think about the possibility of ruptured AAA in people with new abdominal and/or back pain, cardiovascular collapse, or loss of consciousness. Be aware that ruptured AAA is more likely if they also have any of the following risk factors:

Be aware that AAAs are more likely to rupture in women than men.

Offer an immediate bedside aortic ultrasound to people in whom a diagnosis of symptomatic and/or ruptured AAA is being considered. Discuss immediately with a regional vascular service if:

When measuring aortic size with ultrasound, report the inner-to-inner maximum anterior-posterior aortic diameter, in accordance with the NHS AAA screening programme. Clearly document any additional measurements taken.

Offer thin-slice contrast-enhanced arterial-phase CT angiography to people who are being evaluated for elective AAA repair.

Consider thin-slice contrast-enhanced arterial-phase CT angiography for people with a suspected ruptured AAA who are being evaluated for AAA repair.

Be aware that there is no evidence that any single symptom, sign or prognostic risk assessment tool can be used to determine whether people with a suspected or confirmed ruptured abdominal aortic aneurysm (AAA) should be transferred to a regional vascular service.

When making transfer decisions, be aware that people with a confirmed ruptured AAA who have a cardiac arrest and/or have a persistent loss of consciousness have a negligible chance of surviving AAA repair.

For guidance on care of people with a ruptured AAA for whom repair is considered inappropriate, see the NICE guideline on care of dying adults in the last days of life.

When people with a suspected ruptured or symptomatic unruptured AAA have been accepted by a regional vascular service for emergency assessment, ensure that they leave the referring unit within 30 minutes of the decision to transfer.

Consider cardiopulmonary exercise testing when assessing people for elective repair of an asymptomatic abdominal aortic aneurysm (AAA), if it will assist in shared decision making.

For guidance on other preoperative tests, see the NICE guideline on routine preoperative tests for elective surgery.

Do not use any single symptom, sign or patient-related risk factor to determine whether aneurysm repair is suitable for a person with a ruptured AAA.

Do not use patient risk assessment tools (scoring systems) to determine whether aneurysm repair is suitable for a person with a ruptured AAA.

Consider endovascular aneurysm repair (EVAR) or open surgical repair for people with a ruptured infrarenal abdominal aortic aneurysm (AAA). Be aware that:

Consider open surgical repair for people with a ruptured AAA if standard EVAR is unsuitable.

Do not offer complex EVAR to people with a ruptured AAA if open surgical repair is suitable, except as part of a randomised controlled trial comparing complex EVAR with open surgical repair.