Abdominal Aortic Aneurysm

Publication Date: January 3, 2018

Key Points

Key Points

Aneurysms present with varying risks of rupture, and patient-specific factors influence anticipated life expectancy, operative risk, and need to intervene. Careful attention to the choice of operative strategy along with optimal treatment of medical comorbidities is critical to achieving excellent outcomes.

The SVS recommends endovascular repair as the preferred method of treatment for ruptured aneurysms.

The SVS suggests that the Vascular Quality Initiative mortality risk score (https://qxmd.com/calculate/calculator_322/vascular-quality-initiative-vqi-cardiac-risk-index-cri-evar) be used for mutual decision-making with patients considering aneurysm repair.

The SVS also suggest that elective endovascular aneurysm repair (EVAR) be limited to hospitals with a documented mortality and conversion rate to open surgical repair of ≤2% and that perform ≥10 EVAR cases each year. The SVS also suggests that elective open aneurysm repair be limited to hospitals with a documented mortality of ≤5% and that perform ≥10 open aortic operations of any type each year.

The SVS suggests a door-to-intervention time of <90 minutes, based on a framework of 30-30-30 minutes, for the management of the patient with a ruptured aneurysm.

The SVS recommends treatment of type I and III endoleaks as well as of type II endoleaks with aneurysm expansion but recommend continued surveillance of type II endoleaks not associated with aneurysm expansion.

Whereas antibiotic prophylaxis is recommended for patients with an aortic prosthesis before any dental procedure involving the manipulation of the gingival or periapical region of teeth or perforation of the oral mucosa, antibiotic prophylaxis is not recommended before respiratory tract procedures, gastrointestinal or genitourinary procedures, and dermatologic or musculoskeletal procedures unless the potential for infection exists or the patient is immunocompromised.

Increased utilization of color duplex ultarasound is suggested for postoperative surveillance after EVAR in the absence of endoleak or aneurysm expansion.

Diagnosis

...gnosis...

Physical Examin...

...s with a suspected or known abdominal aortic ane...

...n patients with a popliteal or femor...


...sessment of Medical Comorbidities

...with active cardiac conditions, including...

...s with significant clinical risk factors, such...

...nds a preoperative resting 12-lead elect...

...ommends echocardiography before pl...

...he SVS suggests coronary revascula...

...ggests coronary revascularization before aneurysm...

...patients who may need aneurysm repair in the s...

...suggests deferring elective aneurysm repair for 3...

...ts deferring open aneurysm repair for â...

...ith a drug-eluting coronary stent requiring open...

...he SVS suggests continuation of beta blocker...

...s made to start beta blocker therapy (because of t...

...ts preoperative pulmonary function studi...

...he SVS recommends smoking cessation f...

...s administration of pulmonary bronchod...

...SVS suggests holding angiotensin-c...

...SVS recommends preoperative hydration in non-dialy...

...ecommends preprocedure and postpro...

...recommends holding metformin at the tim...

...ecommends restarting metformin no sooner than...

...mmends perioperative transfusion of packed red b...

...VS suggests hematologic assessment if the preop...


...ative Cardiac Evaluation for the Patient Und...


...Functional Capacity Estimation From an Assessment...


...rysm Imaging...

...ds using ultrasound, when feasible, a...

...gests that the maximum aneurysm diameter d...

...SVS recommends a one-time ultrasound s...

...ultrasound screening for AAA in f...

...a one-time ultrasound screening for AAAs in men...

...f initial ultrasound screening ident...

...gests surveillance imaging at 3-year intervals...

...ggests surveillance imaging at 12-month i...

...S suggests surveillance imaging at...

...ds a CT scan to evaluate patients thought to ha...


Treatment

...atment...

The Decision to...

...s referral to a vascular surgeon at the t...

The SVS recommends repair for the pati...

...commends elective repair for the pa...

...ggests elective repair for the patient who presen...

...suggests repair in women with AAA 5.0–5.4...

...h a small aneurysm (4.0–5.4 cm) w...


...nt During the Period of AAA Surveillance...

The SVS recommends smoking cessation to reduce t...

...SVS suggests NOT administering statins,...

...suggests NOT administering beta blocker...


...iming for Interven...

...mmends immediate repair for patients who presen...

...air of a symptomatic AAA be delayed to...


...erative Risk and Life Expectancy...

...VS suggests informing patients contemplati...


...3a. Mortality Risk Scoring Scheme for Patients...


...3b. Risk Categorization Based on Mortality Risk S...


EVA...

...ends preservation of flow to at least one inter...

...SVS recommends using Food and Drug Administ...

...recommends staging bilateral internal iliac ar...

...SVS suggests renal artery or superi...

...s prophylactic treatment of an asymptomatic, high...

...ests preservation of accessory renal arteries a...

...erioperative Outcomes of Elec...

...S suggests that elective EVAR be perform...

...Elective EVAR in the High-Risk and Unfit Patient...

...SVS suggests informing high-risk patients of their...


OS...

...recommends a retroperitoneal approach for pat...

The SVS suggests a retroperitoneal exposure...

...S recommends a thrombin inhibitor, such as b...

...VS recommends straight tube grafts for O...

...ommends performing the proximal aortic anastomos...

...recommends that all portions of an ao...

...recommends reimplantation of a patent IMA...

...SVS recommends preserving blood flow to at lea...

...ts concomitant surgical treatment of other...

...VS suggests concomitant surgical repair o...


...al Approaches for Open Aneurysm Repair Hav...


...perative Outcomes of Open AAA...

...SVS suggests that elective OSR for AAA b...

...timated Perioperative Complications After E...


...nt with a Ruptured Aneurysm

...suggests a door-to-intervention t...

...established protocol for the management of rupt...

...ommends implementing hypotensive h...

...he SVS suggests that patients with rupture...

...anatomically feasible, the SVS recommends EVAR ove...

...uspected Ruptured Abdominal Aortic Aneurys...

...ring Hospital Checklist for the Patient With a Su...

...Receiving Hospital Personnel Alert Checklist for...


...f Anesthetic Technique And Agent...

...ds general endotracheal anesthesia for patients...


...tic Prophylaxis...

...recommends intravenous administrat...

...e SVS recommends that any potential sources of den...


...traoperative Fluid Resuscitation And Bl...

...mmends using cell salvage or an ult...

...operative hemoglobin level is...


...rdiovascular Monitoring...

...suggests using pulmonary artery catheters...

...SVS recommends central venous access and arterial...

...nds postoperative ST-segment monitorin...

...VS recommends postoperative troponin measur...


...aintenance of Body Tem...

...recommends maintaining core body temperature â‰...


...ole of the...

...he SVS recommends postoperative managemen...


...stric Decompression And Perioperative Nutri...

...ecommends optimization of preoperative nutr...

...mmends using nasogastric decompression...

...S recommends parenteral nutrition if a patien...


...phylaxis For Deep Venous Thrombos...

...SVS recommends thromboprophylaxis that includ...

...sts thromboprophylaxis with unfractionated or low...


...stoperative Blood Transfusion...

...the absence of ongoing blood loss...


...perative Pain Management...

...ommends multimodality treatment, i...


Late Outco...

...ecommends treatment of type I endoleak...

...gests treatment of type II endoleak...

...recommends surveillance of type II...

...VS recommends treatment of type II...

...S suggests no treatment of type IV endoleaks...

...recommends open repair if endovascular interventi...

...suggests open repair if endovascular intervent...

...e SVS suggests treatment for ongoing aneurysm...

...SVS recommends that follow-up of pati...

...SVS recommends a prompt evaluation...

...nds antibiotic prophylaxis to prevent g...

...gests antibiotic prophylaxis before respirato...

...urysm repair, the SVS recommends prompt ev...

...ecommends prompt evaluation for possible aort...

In patients presenting with an infected graft in...

...ients presenting with an infected graft with...

...ient presenting with an infected graft,...

In unstable patients with infected...


...ion For Postoperative Surveillanc...

...ecommends baseline imaging in the first month...

...a type II endoleak is observed 1 month after EV...

...neither endoleak nor AAA enlargement is...

...endoleak is associated with an aneurysm sac that...

...w endoleak is detected, the SVS suggests...

...gests non-contrast-enhanced CT imagin...


...doleaksHaving trouble viewing table? Expand...