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Aortic Aneurysm and Aortic Wall Disease G039

Last amended 
11 January 2021
Current RMA Instruments
Reasonable Hypothesis SOP
21 of 2021
Balance of Probabilities SOP
22 of 2021 
Changes from previous Instruments

SOP Bulletin 218

ICD Coding
  • ICD-9-CM Codes: 441.1-9
  • ICD-10-AM Codes: I71
Brief description

An aortic aneurysm is a localised enlargement of the aorta (the main artery from the heart) due to dilatation (expansion) of the aortic wall.  Two thirds occur in the abdominal aorta with the remainder in the thoracic aorta (in the ascending or descending part, or the arch).

Aortic wall disorders are defined in the SOP as aortic dissection, aortic intramural haematoma, false or psuedo aneurysm of the aorta, periaortic haemtoma, rupture of the aorta and symptomatic penetrating aortic ulcer. For further details see comments section below. 

Confirming the diagnosis

The diagnosis may be provisionally made on physical examination, but requires confirmation by imaging (ultrasound, CT scan or MRI) or at operation. Hospital notes or specialist correspondence, if available, is likely to assist in confirming the diagnosis. 

The relevant medical specialist is a vascular surgeon.

Additional diagnoses covered by SOP
  • Aortic intramural haematoma
  • Abdominal aortic aneurysm
  • Dissection of the aorta
  • False (pseudo) aneurysm of the aorta
  • Periaortic haemtoma
  • Rupture of the aorta
  • Ruptured aortic aneurysm
  • Symptomatic penetrating aortic ulcer
  • Thoracic aortic aneurysm
Conditions not covered by SOP
  • Non-aneurysmal aortic atherosclerotic disease*

* Another SOP applies

Clinical onset

The presentation of these conditions can range from asymptomatic and found incidentally by physical examination or imaging through to medical emergency or sudden death. Onset will be at the time of first presentation or detection. 

Clinical worsening

The natural history of an aortic aneurysm is for progressive expansion to occur.  Specialist opinion will generally be required to identify if there has been worsening beyond the normal course of the disease.  Treament in most cases is conservative, with elective surgery reserved for aneurysms of large size or high risk of rupture. 

Aortic wall disorders will commonly present as medical emergencies with threat to life and requirement for urgent surgery. As for aortic aneurysm, identification of worsening beyond the normal course of disease for these conditions will generally require specialist opinion. 

  • Aortic intramural haematoma - involves bleeding and subsequent haematoma formation within the aortic wall.
  • Dissecting aortic aneurysm – involves separation of the layers of the aortic wall, allowing blood to leak between the layers.
  • False or pseduo aneurysm of the aorta - blood leaks out of the aorta but is confined next to the vessel by surrounding tissue. Due to trauma, atherosclerosis or infection.
  • Periaortic haematoma - bleeding and subsequent haematoma formation in the tissues surrounding the aorta.
  • Rupture of the aorta - a break or tear through all layers of the aortic wall
  • Symptomatic penetrating aortic ulcer (an ulcer of sufficient depth to have broken through at least one layer of the aortic wall) 
  • True aortic aneurysm – involves bulging of all three layers of the aortic wall and at least 50% increase in expected diameter compared to the normal expected diameter.