Abdominal Aortic Aneurysm
Key Points
Key Points
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
...iagnosi...
Physical Examinati...
...tients with a suspected or known abdom...
...ts with a popliteal or femoral artery an...
...of Medical Comorbidities...
...nts with active cardiac conditions, i...
...ients with significant clinical risk factor...
...commends a preoperative resting 12-lead electr...
...recommends echocardiography before pla...
...S suggests coronary revascularization be...
...ests coronary revascularization before aneur...
...ho may need aneurysm repair in the subsequent...
...e SVS suggests deferring elective an...
...ggests deferring open aneurysm repa...
...h a drug-eluting coronary stent requiring open an...
...gests continuation of beta blocker ther...
...decision was made to start beta block...
...ts preoperative pulmonary function studies, inc...
The SVS recommends smoking cessation for â...
...administration of pulmonary bronchodi...
The SVS suggests holding angiotensin-converting e...
...SVS recommends preoperative hydration...
...nds preprocedure and postprocedure hydrat...
...mends holding metformin at the time of administrat...
The SVS recommends restarting metfo...
The SVS recommends perioperative transfusion o...
...gests hematologic assessment if the preoperati...
...le 1. Preoperative Cardiac Evaluation fo...
Table 2. Functional Capacity Estimation From a...
...urysm Imaging
...ends using ultrasound, when feasible...
...ts that the maximum aneurysm diamet...
...ds a one-time ultrasound screening for AAAs...
The SVS suggests ultrasound screening for AAA i...
...ts a one-time ultrasound screening fo...
If initial ultrasound screening identified an...
...ts surveillance imaging at 3-year intervals...
The SVS suggests surveillance imaging at...
...suggests surveillance imaging at 6-month interval...
...SVS recommends a CT scan to evaluate p...
Treatment
Treatmen...
...cision to Treat...
...S suggests referral to a vascular sur...
...ds repair for the patient who presents wit...
...ecommends elective repair for the patient...
...ts elective repair for the patient who presents w...
...sts repair in women with AAA 5.0–5.4 cm in m...
...with a small aneurysm (4.0–5.4 cm) who w...
...nagement During the Period of AAA Su...
...SVS recommends smoking cessation to reduce the...
...ggests NOT administering statins, doxycycline, r...
...S suggests NOT administering beta blocker ther...
...iming for Interven...
...mmends immediate repair for patients who...
...hould repair of a symptomatic AAA be delayed to o...
...Operative Risk and Life Expectanc...
The SVS suggests informing patients co...
...Mortality Risk Scoring Scheme for Patients Under...
...e 3b. Risk Categorization Based on Mor...
...VAR
...ecommends preservation of flow to at least one i...
...mmends using Food and Drug Administration...
...S recommends staging bilateral internal...
...s renal artery or superior mesenteri...
...S suggests prophylactic treatment of a...
...gests preservation of accessory renal arteries at...
...operative Outcomes of Elective E...
...SVS suggests that elective EVAR be performed at...
...ve EVAR in the High-Risk and Unfit...
...S suggests informing high-risk patients of thei...
OSR
...mends a retroperitoneal approach for patien...
...he SVS suggests a retroperitoneal exposure or...
...ds a thrombin inhibitor, such as bivalirudin...
...mmends straight tube grafts for OSR of...
...recommends performing the proximal aortic an...
The SVS recommends that all portions o...
...ds reimplantation of a patent IMA u...
...ommends preserving blood flow to at leas...
...SVS suggests concomitant surgical treatme...
...s concomitant surgical repair of an...
...ical Approaches for Open Aneurysm Repair...
...rioperative Outcomes of Open AAA Repair...
...SVS suggests that elective OSR for...
.... Estimated Perioperative Complications Af...
...tient with a Ruptured Aneu...
...s a door-to-intervention time of...
...rotocol for the management of rupt...
...e SVS recommends implementing hypoten...
...suggests that patients with ruptured AAA w...
...ically feasible, the SVS recommends EV...
...1. Suspected Ruptured Abdominal Aortic Aneurysm...
...ng Hospital Checklist for the Patient With...
.... Receiving Hospital Personnel Alert Checkl...
...Anesthetic Technique And Agent...
...ommends general endotracheal anesthesia for pat...
...tibiotic Prophyl...
...ds intravenous administration of a fir...
...S recommends that any potential sources of denta...
...e Fluid Resuscitation And Blood Conser...
...S recommends using cell salvage or an...
...traoperative hemoglobin level is...
...rdiovascular Monitoring
...s using pulmonary artery catheters...
...recommends central venous access a...
...SVS recommends postoperative ST-segment...
...ds postoperative troponin measurement for...
...aintenance of Body Temper...
...mends maintaining core body temperature ≥36º...
...of the ICU...
...ommends postoperative management in an I...
...ecompression And Perioperative Nutrition...
...ommends optimization of preoperative nutritio...
...e SVS recommends using nasogastric decompression...
...he SVS recommends parenteral nutrition if...
...laxis For Deep Venous Thromb...
...ends thromboprophylaxis that includes interm...
...thromboprophylaxis with unfractionated or low-...
...ostoperative Blood Transfusion
...of ongoing blood loss, the SVS suggests a thre...
...rative Pain Management...
...ecommends multimodality treatment,...
Late Outcome...
...he SVS recommends treatment of type I end...
...s treatment of type II endoleaks associated wi...
...S recommends surveillance of type II endo...
...mmends treatment of type III endoleaks. ( 1 â€...
...e SVS suggests no treatment of type IV endoleaks....
...ds open repair if endovascular intervention fai...
...e SVS suggests open repair if endovascular int...
...uggests treatment for ongoing aneurysm expansion,...
...recommends that follow-up of patients af...
...S recommends a prompt evaluation for pos...
...e SVS recommends antibiotic prophy...
...VS suggests antibiotic prophylaxis before...
...epair, the SVS recommends prompt eva...
...ommends prompt evaluation for possible aortoe...
...presenting with an infected graft in the...
...ients presenting with an infected...
...e patient presenting with an infected gr...
...ble patients with infected graft, the SVS reco...
...For Postoperative Surveillance...
...S recommends baseline imaging in the...
...oleak is observed 1 month after EVAR, the...
...endoleak nor AAA enlargement is obse...
...ndoleak is associated with an aneurys...
...ew endoleak is detected, the SVS suggests evalu...
...gests non-contrast-enhanced CT imaging of th...
...e 8. EndoleaksHaving trouble viewing tab...