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
...Diagnosis...
...Physical Exa...
...th a suspected or known abdominal aortic aneury...
...tients with a popliteal or femoral artery aneu...
...Asses...
...tients with active cardiac conditions, in...
...patients with significant clinical...
...nds a preoperative resting 12-lead elec...
...ecommends echocardiography before planne...
...S suggests coronary revascularization be...
...ts coronary revascularization before aneurysm...
...who may need aneurysm repair in the subseq...
...ggests deferring elective aneurysm...
...ts deferring open aneurysm repair for ≥6 mont...
...th a drug-eluting coronary stent requiring...
...suggests continuation of beta blocker th...
...sion was made to start beta blocker therapy (be...
...suggests preoperative pulmonary function studie...
...ommends smoking cessation for ≥2 w...
...e SVS suggests administration of pulmonary...
...VS suggests holding angiotensin-con...
...recommends preoperative hydration in no...
...mmends preprocedure and postprocedure...
...SVS recommends holding metformin at the time o...
...recommends restarting metformin n...
...ecommends perioperative transfusion of p...
...SVS suggests hematologic assessment if the pr...
...1. Preoperative Cardiac Evaluation for the Pa...
...e 2. Functional Capacity Estimation Fro...
...Aneurysm Ima...
...mmends using ultrasound, when feasible,...
...ests that the maximum aneurysm diameter der...
...SVS recommends a one-time ultrasound screening...
The SVS suggests ultrasound screening for...
...e SVS suggests a one-time ultrasound sc...
...initial ultrasound screening identi...
...he SVS suggests surveillance imaging at 3-year int...
...e SVS suggests surveillance imaging at...
...e SVS suggests surveillance imaging...
...SVS recommends a CT scan to evalu...
Treatment
...The Decision t...
...sts referral to a vascular surgeon...
...commends repair for the patient who presents with...
...mends elective repair for the patient at low or ac...
...VS suggests elective repair for the pa...
...gests repair in women with AAA 5.0–5.4 cm...
...ith a small aneurysm (4.0–5.4 cm) who will...
...Medical Managem...
...mmends smoking cessation to reduce the risk o...
...ggests NOT administering statins, d...
...he SVS suggests NOT administering beta blocke...
...Timing for Int...
The SVS recommends immediate repair...
...epair of a symptomatic AAA be delayed t...
...Assessment of Operati...
...S suggests informing patients contemplating o...
...ortality Risk Scoring Scheme for Patie...
...k Categorization Based on Mortality Risk Scoring...
...EV...
...e SVS recommends preservation of flow to at le...
...SVS recommends using Food and Drug...
...mends staging bilateral internal iliac artery occl...
...renal artery or superior mesenteric...
...s prophylactic treatment of an asymp...
...uggests preservation of accessory renal art...
...Perioperative Outc...
...ests that elective EVAR be performed at cente...
...Role of Electi...
...suggests informing high-risk patients...
...e SVS recommends a retroperitoneal approach for p...
...S suggests a retroperitoneal exposure or a tr...
...SVS recommends a thrombin inhibitor, suc...
...e SVS recommends straight tube graft...
...SVS recommends performing the proximal aortic an...
...mmends that all portions of an aor...
...e SVS recommends reimplantation of a...
...VS recommends preserving blood flow to at lea...
...gests concomitant surgical treatment of...
...SVS suggests concomitant surgical...
...ble 4. Surgical Approaches for Open A...
...Perioperative O...
...SVS suggests that elective OSR for AAA b...
...Estimated Perioperative Complicati...
...The Patient wit...
...he SVS suggests a door-to-intervention time o...
...tablished protocol for the management of...
...S recommends implementing hypotensive hemostasis...
...ts that patients with ruptured AAA who requ...
...anatomically feasible, the SVS reco...
...e 1. Suspected Ruptured Abdominal Aortic A...
...Referring Hospital Checklist for the P...
...ving Hospital Personnel Alert Check...
...Choice Of A...
...ds general endotracheal anesthesia for patients u...
...Antibiotic Prophylaxis...
...recommends intravenous administrati...
...e SVS recommends that any potential...
...Intraoperat...
...commends using cell salvage or an u...
...erative hemoglobin level is...
...Cardiovascular...
...ests using pulmonary artery catheters only...
...mends central venous access and arteri...
...SVS recommends postoperative ST-segment monitoring...
...ecommends postoperative troponin measuremen...
...Maintena...
...ends maintaining core body tempera...
...Role of the ICU...
...mends postoperative management in an ICU for the...
...Nasogastric Decompres...
...SVS recommends optimization of preope...
...commends using nasogastric decompression i...
...e SVS recommends parenteral nutrition if a patient...
Prophylaxi...
...recommends thromboprophylaxis that include...
The SVS suggests thromboprophylaxis with unfrac...
...Postoperative Bloo...
...ce of ongoing blood loss, the SVS...
...Perioperat...
...e SVS recommends multimodality treat...
...L...
The SVS recommends treatment of type I end...
...suggests treatment of type II endole...
...he SVS recommends surveillance of type II endolea...
...commends treatment of type III endoleaks...
...gests no treatment of type IV endoleaks. ( 2 – W...
...S recommends open repair if endovascular inter...
...ts open repair if endovascular interv...
...VS suggests treatment for ongoing aneu...
...commends that follow-up of patients after...
...mmends a prompt evaluation for possible...
...ds antibiotic prophylaxis to preven...
...ts antibiotic prophylaxis before respiratory tr...
...rysm repair, the SVS recommends prompt eva...
...recommends prompt evaluation for possible aortoen...
...n patients presenting with an infected graft...
...ents presenting with an infected graft w...
...tient presenting with an infected graft,...
...n unstable patients with infected gr...
...Recommendation For Post...
...commends baseline imaging in the fir...
...II endoleak is observed 1 month after EVAR...
...endoleak nor AAA enlargement is observed...
If a type II endoleak is associated with...
...a new endoleak is detected, the SVS...
...he SVS suggests non-contrast-enhanced CT im...
...8. Endoleaks Type Des...