Guidance

Abdominal aortic aneurysm screening pathway requirements specification

Published 21 June 2021

Applies to England

This publication provides an overview of the NHS abdominal aortic aneurysm (AAA) screening programme by describing what should happen at each stage of the pathway. It should be read alongside other guidance for the NHS abdominal aortic aneurysm (AAA) programme, including:

• operational and training guidance for local NHS AAA screening programme providers

• screening standards

Local commissioners and providers should also review schedules 2 and 4 of the AAA specification (number 23) held by the NHS England (NHSE) public health commissioning and operations team.

Please also read the general information relevant to all the NHS screening programme pathways.

AAA screening

The NHS offers an ultrasound scan to men during the screening year (1 April to 31 March) in which they turn 65. Men over the age of 65 can refer themselves for a scan if they have not had one.

Screening is not routinely offered to groups where there is a smaller risk of an AAA. These are:

• men under the age of 65
• women
• anyone who has already been treated for an AAA

This scan is a way of checking if there is a bulge or swelling in the abdominal aorta, the main blood vessel that runs from the heart down to the tummy. The purpose of the programme is to identify any swelling in the aorta at an early stage to reduce deaths from AAAs.

There are 4 possible AAA screening results based on the size of the abdominal aorta. They are:

• no AAA found (less than 3.0cm)
• small AAA (3.0cm to 4.4cm)
• medium AAA (4.5cm to 5.4cm)
• large AAA (5.5cm and larger)

Men are placed under surveillance if they are found to have a small or medium aneurysm, to see if the aneurysm increases in size.

Men found to have a large aneurysm are offered a referral to vascular services.

Find out more in the AAA screening programme overview.

End-to-end pathway

The pathway for the AAA screening programme consists of the following elements.

The dotted boxes and numbered labels show how the different parts of the pathway map to the generic headings used below.

An accessible text-only version of this pathway is also available.

1. Before screening test

These requirements relate to making sure that screening is offered to the correct people.

Providers should have systems in place to:

• make sure eligible men are offered AAA screening
• make sure invited men are signposted to or given the AAA screening information leaflet
• offer men the easy read version or a translated version of the AAA screening information leaflet, where appropriate
• make sure everyone involved in local delivery of AAA screening has access to, and knows how to operate, SMaRT (Screening Management and Referral Tracking), the national AAA screening IT system
• make sure all information about men, including their AAA results, is inputted correctly in SMaRT (from the offer of screening, to the end of the pathway)
• make sure the Screening Quality Assurance Service (SQAS) is notified of any incidents within the screening pathway as set out in the incident management procedures

Uptake

Providers should follow the national guidance to validate the appropriate quarterly and annual data for:

• uptake standard AAA-S01: initial screen offer
• uptake standard AAA-S02: annual surveillance offer
• uptake standard AAA-S03: quarterly surveillance offer
• uptake standard AAA-S08: initial screen
• uptake standard AAA-S09: annual surveillance scan
• uptake standard AAA-S10: quarterly surveillance scan

Coverage

Providers should follow the national guidance to validate the appropriate quarterly and annual data for:

• coverage standard AAA-S04: initial screen (KPI AA2)
• coverage standard AAA-S05: annual surveillance scan (KPI AA3)
• coverage standard AAA-S06: quarterly surveillance scan (KPI AA4)
• coverage standard AAA-S07: initial screen in most deprived 30% of local areas

2. Screening test

These requirements relate to the processes of carrying out the screening test.

Carrying out the screening test

Providers should have systems in place to:

• provide men with information about the test and obtain informed consent before the scan
• perform the ultrasound scan in accordance with the AAA screening clinical guidance and scope of practice document
• give men the results of their ultrasound on the day of their test, including:
  • telling men who do not have an aneurysm detected that they do not need any more scans and will not receive any more invitations for AAA screening
  • explaining to those men who do have an aneurysm detected that they will receive further appointments to monitor the size of it
  • explaining to men whose aorta could not be visualised on the day of their test that they will receive a further invitation for screening
• monitor the number of inconclusive scans and validate the appropriate quarterly data for test standard AAA-S11: non-visualised initial screens
• monitor the proportion of abnormal screens reviewed in less than 21 calendar days of the initial screen date for test standard AAA-S12: time to internal QA
• make sure clinical skills trainers and screening technicians are competent and meet the training requirements as set out in AAA screening: education and training

Surveillance

Surveillance requirements relate to the process of scanning men with aneurysms between 3cm to 5.4cm to check if their AAAs are getting bigger. Providers should have systems in place to:

• offer yearly surveillance scans to men with small aneurysms, and every 3 months to men with medium size aneurysms
• make sure men receive either the Monitoring your small abdominal aortic aneurysm or Monitoring your medium abdominal aortic aneurysm information, as appropriate
• contact and offer all screen detected men a face to face appointment with a vascular nurse specialist, who will provide health and lifestyle advice
• validate appropriate quarterly data for diagnosis/intervention standard AAA-S13: time to nurse assessment

3. After screening test (diagnosis)

These requirements relate to the process of following-up screen detected results to get a confirmed result.

Referral

Providers should have systems in place to:

• provide men with the information on managing and monitoring a large AAA
• refer men identified with a large aneurysm to a vascular service within one working day
• validate the appropriate quarterly data for diagnosis/intervention standard AAA-S14: time to first vascular surgeon assessment

The vascular service should have systems in place to offer the man an appointment to see a vascular specialist within 2 weeks of his scan to talk about treatment options.

4. After screening test (intervention)

These requirements relate to the process of following-up people with a confirmed diagnosis (large aneurysm) and maximising the overall benefits from screening in terms of the final outcome to the person being screened.

Providers should have systems in place to:

• make sure a vascular surgeon treats all men who are fit and opt for surgery within 8 weeks of the man’s scan
• validate the appropriate quarterly data for diagnosis/intervention standard AAA-S15: time to vascular surgery
• remind the vascular service to enter the date of surgery into the national vascular registry (NVR)

Points at which active inclusion in the programme ends can be found in the AAA screening: standard operating procedure.