Journey for aneurysm diagnosis and treatment.

if you're enrolled in the National Screening Programme or you are just screened locally for an aneurysm or if one is just discovered incidentally then normally the first step would be to refer you to a vascular surgeon often then you would have a consultation to discuss the aneurysm also to ask some questions about what you would like done about it how fit you are and whether or not repairing your aneurysm at the size it is would be a useful thing to do Generally speaking, the next step after that is to get a CT scan, sometimes you'll be referred with a CT scan already because it's been detected on CT, but the function of the CT scan is to look at, again, the size to confirm that it is over the threshold for treatment, also to look at the features of the aneurysm and whether or not it can be treated with a stent graft or whether or not you'll have to have an open repair or if the repair is in fact complicated by the fact that the aneurysm extends above the kidney arteries or even into the chest. Once that CT scan is done and we know what treatment options are available, then what happens next tends to vary between units. At my unit and in several others around the country, we use cardiopulmonary exercise testing which involves getting onto an exercise bike, pedalling for a bit, doing a sort of ramped test of how well you can peddle over a period of time, and that gives us information about how well your heart and lungs work and then also some information about your life expectancy and that kind of thing. Other units don't use this and they might opt for an echocardiogram, sometimes that's the stress echo where you get injected with a medicine which makes your heart beat quicker and then we can see how the heart reacts under strain and pulmonary function tests which involve just blowing into a tube which then gives us information about the health of the lungs. Once we have all this together usually you'll then discuss at a multidisciplinary team meeting at the hospital or in the region where we go over the investigations and look at the images and then decide finally what would be the best course of action. Often too you'll have an anaesthetic review and a chance to talk to the anaesthetist about the again your fitness and your wishes for surgery and they can look at the information gotten from the tests. When all this is done then we can come to a conclusion about what's best. There might be a choice to have an open or endovascular repair or sometimes if you're not very fit and an endovascular repair is possible it might be that's the only option that's realistically available to you and then we can make a date for surgery and get you onto a waiting list and get the operation done.