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Emergency
·
medium
Unstable Abdominal Aortic Aneurysm
Flowchart
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Stable + AAA on CT vs unstable + bedside US → OR.
Decision
Outcome
Decision
Abdominal/flank/groin pain + pulsatile mass. Stable?
✓
Stable → CT abdomen with contrast
✓
Unstable → bedside abdominal US (do NOT delay for CT)
Decision
Stable patient — CT findings?
✓
AAA confirmed → medical optimization, elective/urgent repair
✓
No AAA → explore other diagnoses
Outcome
Repair: open or EVAR depending on anatomy and comorbidities
Outcome
Workup other causes of pain
Decision
Unstable + bedside US shows AAA?
✓
Yes → emergency repair (EVAR or open)
✓
No → explore other diagnoses
Outcome
Emergency surgical repair — call vascular surgery, mass transfusion protocol
Permissive hypotension (SBP 70–90) until aortic control to limit hematoma expansion.