What are the discharge instructions for a 75-year-old male with an aortic aneurysm from the Emergency Room (ER)?

Discharge Instructions for a 75-Year-Old Male with Aortic Aneurysm from ER

For a 75-year-old male with an aortic aneurysm being discharged from the ER, close monitoring with regular follow-up imaging is essential, with surgical intervention recommended if the aneurysm reaches 5.5 cm or larger to prevent rupture and death. 1

Aneurysm Size-Based Management

Small Aneurysm (< 5.5 cm)

• Follow-up schedule:
  • Aneurysm 3.0-3.9 cm: Ultrasound every 2-3 years
  • Aneurysm 4.0-4.4 cm: Ultrasound every 12 months
  • Aneurysm 4.5-5.4 cm: Ultrasound every 6 months 1
• Medical management:
  • Strict blood pressure control (target < 130/80 mmHg)
  • Statin therapy regardless of cholesterol levels
  • Smoking cessation is mandatory - this is the most important modifiable risk factor 2, 3
  • Beta-blockers may be considered to reduce aortic wall stress

Large Aneurysm (≥ 5.5 cm)

• Urgent vascular surgery consultation before discharge
• Surgical intervention is recommended as mortality risk from rupture significantly increases 1, 4
• Two surgical options:
  • Open surgical repair: Traditional approach with higher perioperative risk but excellent long-term durability
  • Endovascular aneurysm repair (EVAR): Less invasive option with lower short-term mortality but requires lifelong surveillance 1, 5

Warning Signs Requiring Immediate Return to ER

• Severe abdominal or back pain (especially if sudden onset)
• Syncope or dizziness
• Pulsating sensation in abdomen
• Signs of shock: cold/clammy skin, rapid heart rate, confusion
• Any new symptoms that concern the patient 5

Lifestyle Modifications

• Complete smoking cessation - this can slow aneurysm growth
• Regular moderate exercise (avoid heavy lifting >50 pounds)
• Dietary changes: low-sodium diet to help control blood pressure
• Avoid activities that cause Valsalva maneuver or extreme exertion 3

Follow-up Appointments

• Primary care physician: within 1 week
• Vascular surgeon: within 2 weeks (sooner if aneurysm ≥5.5 cm)
• Bring all medications to appointments
• Ensure imaging studies are available for specialist review

Mortality Risk Considerations

The mortality rate for ruptured AAAs is extremely high (65-85%), making proper surveillance and timely intervention critical 5. For patients with aneurysms >7.0 cm who do not undergo repair, median survival is only about 9 months, with over 50% dying from rupture 4. This underscores the importance of appropriate intervention when indicated, as the natural history of untreated large aneurysms is poor.

Special Considerations for This Patient

At 75 years of age, this patient is at the upper age limit for standard screening recommendations 1, but management should still be aggressive if he has reasonable life expectancy and functional status. The risk-benefit analysis favors intervention for aneurysms ≥5.5 cm even in older patients, as the risk of rupture outweighs surgical risks in most cases 1, 4.