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

...agnosi...

...sical Examination

...n patients with a suspected or known abdomina...

In patients with a popliteal or femoral artery ane...


...essment of Medical Comorbidities

...ith active cardiac conditions, including unstabl...

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

...mends a preoperative resting 12-lead electroc...

...ecommends echocardiography before planned...

...ts coronary revascularization before aneurysm...

...gests coronary revascularization before...

...who may need aneurysm repair in the sub...

...e SVS suggests deferring elective aneurysm...

...s deferring open aneurysm repair for ≥...

...n patients with a drug-eluting coronary stent requ...

...ts continuation of beta blocker therapy during...

...was made to start beta blocker therapy (because...

...he SVS suggests preoperative pulmonary func...

...ommends smoking cessation for ≥2 weeks befo...

...e SVS suggests administration of pulmonary bron...

...S suggests holding angiotensin-converting...

...commends preoperative hydration in non-dialysis...

...e SVS recommends preprocedure and postprocedure...

...ommends holding metformin at the time of...

...ecommends restarting metformin no s...

...mmends perioperative transfusion of packed r...

...ests hematologic assessment if the...


.... Preoperative Cardiac Evaluation for...


...nal Capacity Estimation From an Assessment of Ph...


...eurysm Imaging...

...mmends using ultrasound, when feasible, as t...

...ggests that the maximum aneurysm diameter deri...

...ommends a one-time ultrasound scree...

...SVS suggests ultrasound screening f...

The SVS suggests a one-time ultrasound screening...

...l ultrasound screening identified an aortic...

...uggests surveillance imaging at 3-year int...

...gests surveillance imaging at 12-month interval...

...ggests surveillance imaging at 6-month interv...

...recommends a CT scan to evaluate patients...


Treatment

...reatment...

The Decision to T...

...ggests referral to a vascular surgeon at...

...SVS recommends repair for the patient w...

...mends elective repair for the patient at...

...suggests elective repair for the patient...

...VS suggests repair in women with AAA 5...

...a small aneurysm (4.0–5.4 cm) wh...


...edical Management During the Period...

...recommends smoking cessation to reduce the r...

The SVS suggests NOT administering statins, doxyc...

...NOT administering beta blocker therapy for the so...


...ming for Interventio...

...ds immediate repair for patients who pre...

...repair of a symptomatic AAA be delay...


...ssessment of Operative Risk and Li...

...gests informing patients contemplatin...


...able 3a. Mortality Risk Scoring Scheme...


...Risk Categorization Based on Mortalit...


...VAR...

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

...recommends using Food and Drug Admini...

...SVS recommends staging bilateral internal iliac...

...ts renal artery or superior mesenteric artery (...

...SVS suggests prophylactic treatment of a...

...suggests preservation of accessory...

...operative Outcomes of Elective E...

...uggests that elective EVAR be performed a...

Role of Elective EVAR in the High-Risk and Unfit...

...S suggests informing high-risk patients...


...SR

The SVS recommends a retroperitoneal approach f...

...SVS suggests a retroperitoneal exp...

...SVS recommends a thrombin inhibitor, such as bi...

...nds straight tube grafts for OSR of...

...ecommends performing the proximal aortic...

...recommends that all portions of an aor...

...he SVS recommends reimplantation o...

...ecommends preserving blood flow to at le...

...sts concomitant surgical treatment of other...

...e SVS suggests concomitant surgical repair of an...


...ical Approaches for Open Aneurysm Repair ...


...ioperative Outcomes of Open AAA...

...uggests that elective OSR for AAA be performed...

...5. Estimated Perioperative Complications After...


...tient with a Ruptured Aneurysm...

...a door-to-intervention time of...

...ed protocol for the management of ruptured...

...e SVS recommends implementing hypotensive hemosta...

...S suggests that patients with rupt...

...t is anatomically feasible, the SVS recommend...

...re 1. Suspected Ruptured Abdominal Aortic Aneurysm...

...ble 6. Referring Hospital Checklist for the Pat...

...ng Hospital Personnel Alert Checklist for Manage...


...Of Anesthetic Technique And...

...ecommends general endotracheal anesthesia for pati...


Antibiotic Prophylaxis

...he SVS recommends intravenous administration of a...

...ecommends that any potential sources of dental s...


...operative Fluid Resuscitation And Blood Conse...

...nds using cell salvage or an ultraf...

...raoperative hemoglobin level is...


...scular Monitoring...

...ests using pulmonary artery catheters only if...

...SVS recommends central venous access a...

...ends postoperative ST-segment monitoring for al...

...ommends postoperative troponin measurement f...


...ce of Body Temperatur...

...recommends maintaining core body temperature ...


...of the ICU...

...ommends postoperative management in an ICU for...


...Decompression And Perioperative Nu...

...commends optimization of preoperative nutritio...

...recommends using nasogastric decompression intra...

...ecommends parenteral nutrition if a patient...


...rophylaxis For Deep Venous Throm...

...mends thromboprophylaxis that includes...

...sts thromboprophylaxis with unfractionated or lo...


...ostoperative Blood Tran...

...ence of ongoing blood loss, the SVS suggests...


...operative Pain Management...

...SVS recommends multimodality treatment, includi...


...te Outcome...

...ommends treatment of type I endoleaks. (...

The SVS suggests treatment of type...

...ds surveillance of type II endoleaks...

...mends treatment of type III endolea...

...sts no treatment of type IV endolea...

...recommends open repair if endovascular in...

...sts open repair if endovascular intervention fa...

...SVS suggests treatment for ongoing...

...mends that follow-up of patients after aneurysm re...

...ends a prompt evaluation for possible graft limb...

...ecommends antibiotic prophylaxis to...

...sts antibiotic prophylaxis before respirat...

...neurysm repair, the SVS recommends pro...

...recommends prompt evaluation for possible aor...

...resenting with an infected graft in the presence o...

...patients presenting with an infected graf...

...n a stable patient presenting with an...

...n unstable patients with infected graft,...


...endation For Postoperative Survei...

...mends baseline imaging in the first...

...e II endoleak is observed 1 month after EVAR, th...

If neither endoleak nor AAA enlarge...

...a type II endoleak is associated with an...

...new endoleak is detected, the SVS su...

...ts non-contrast-enhanced CT imaging of...


...able 8. EndoleaksHaving trouble vie...