Ruptured Abdominal Aortic Aneurysm — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Hemodynamically stable?
   Is the patient hemodynamically stable? (Ruptured abdominal aortic aneurysm (infrarenal ≥3 cm), triad = hypotension + flank/back pain + pulsatile abdominal mass (all three present in only 25–50%); abdominal/back/flank/groin pain is most common; often misdiagnosed as renal colic/diverticulitis/GI bleed. >50% present with rupture as the first event, untreated mortality >80%. Strongly suspect in anyone >50 with acute abdominal/flank pain + hypotension.)
   • Unstable (shock) → Unstable → straight to OR
   • Relatively stable → Relatively stable → CTA + vascular surgery
2. [End] Relatively stable → CTA + vascular surgery
   Relatively stable, strong suspicion: high-flow oxygen, two large-bore IV lines, cross-match ≥6 units; permissive hypotension (target SBP ~70–90 mmHg, no aggressive fluids); urgent CTA to assess EVAR suitability; urgent vascular surgery consult/transfer. Treat as unstable the moment it deteriorates.
3. [End] Unstable → straight to OR
   Unstable/shock: straight to the operating room for open repair (on clinical signs ± bedside ultrasound; do not delay for imaging); activate the massive transfusion protocol, permissive hypotension (to avoid dislodging clot and the lethal triad: hypothermia/acidosis/coagulopathy); reverse anticoagulation; urgent vascular surgery. Bedside ultrasound can show the aneurysm (but cannot show rupture).

Source guidelines & references

• Ruptured abdominal aortic aneurysm (Merck Manual; StatPearls); IMPROVE trial

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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