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
Diagnos...
...sical Examination
...h a suspected or known abdominal ao...
...n patients with a popliteal or femoral arter...
...sessment of Medical Comorbidities
...with active cardiac conditions, includi...
...with significant clinical risk factors, such...
...ecommends a preoperative resting 12-lead elec...
...recommends echocardiography before pl...
...e SVS suggests coronary revasculari...
...SVS suggests coronary revascularizatio...
...who may need aneurysm repair in the su...
...ggests deferring elective aneurysm repair f...
...SVS suggests deferring open aneurysm repair fo...
...ts with a drug-eluting coronary stent requi...
The SVS suggests continuation of beta blocker t...
...was made to start beta blocker therapy (bec...
...suggests preoperative pulmonary function stud...
...ends smoking cessation for ≥2 weeks befor...
...gests administration of pulmonary bronchodilat...
...gests holding angiotensin-converting...
...nds preoperative hydration in non-...
The SVS recommends preprocedure and postp...
...SVS recommends holding metformin at the t...
...he SVS recommends restarting metformin n...
...SVS recommends perioperative transfusion of pa...
...gests hematologic assessment if the preoperat...
...erative Cardiac Evaluation for the Patie...
...e 2. Functional Capacity Estimation Fro...
...rysm Imaging...
...e SVS recommends using ultrasound, whe...
...ggests that the maximum aneurysm diam...
...nds a one-time ultrasound screening for AAAs i...
...e SVS suggests ultrasound screening for...
...e SVS suggests a one-time ultrasound screening...
...trasound screening identified an aortic diameter...
...uggests surveillance imaging at 3-year...
...s surveillance imaging at 12-month...
...gests surveillance imaging at 6-month i...
...ends a CT scan to evaluate patients...
Treatment
...reatmen...
...ecision to Trea...
...he SVS suggests referral to a vascular surg...
...he SVS recommends repair for the patient who pr...
...ends elective repair for the patient at lo...
...SVS suggests elective repair for t...
The SVS suggests repair in women with AAA 5.0–5....
...with a small aneurysm (4.0–5.4 cm) who w...
...ement During the Period of AAA Surveillanc...
...commends smoking cessation to reduce the...
...S suggests NOT administering statins, doxycyc...
The SVS suggests NOT administering beta blo...
...ing for Intervent...
...mmends immediate repair for patients w...
...of a symptomatic AAA be delayed t...
...Operative Risk and Life Expectancy...
...gests informing patients contemplati...
...Mortality Risk Scoring Scheme for Patients...
...3b. Risk Categorization Based on M...
...VAR...
...nds preservation of flow to at least one...
...e SVS recommends using Food and Drug...
...mends staging bilateral internal iliac artery occ...
...S suggests renal artery or superior mesenteric...
...sts prophylactic treatment of an asymptomatic,...
...SVS suggests preservation of accessory renal arte...
...operative Outcomes of Elective EVAR...
...that elective EVAR be performed at centers wit...
...Elective EVAR in the High-Risk and Unfit...
...VS suggests informing high-risk patients o...
...SR
The SVS recommends a retroperitoneal approach...
...S suggests a retroperitoneal exposure or a...
The SVS recommends a thrombin inhibitor, such as...
...ds straight tube grafts for OSR of A...
...he SVS recommends performing the proximal aort...
...nds that all portions of an aortic gra...
...recommends reimplantation of a patent IMA u...
...recommends preserving blood flow to...
...he SVS suggests concomitant surgical treatment...
...suggests concomitant surgical repair of an AA...
...le 4. Surgical Approaches for Open Aneurysm...
...erative Outcomes of Open AAA Repair...
...VS suggests that elective OSR for AAA be perfor...
...ated Perioperative Complications After E...
...ient with a Ruptured Aneurysm...
...sts a door-to-intervention time of...
...protocol for the management of ruptured AAA...
...nds implementing hypotensive hemostasis with re...
...sts that patients with ruptured AAA who require tr...
...atomically feasible, the SVS recommends...
...pected Ruptured Abdominal Aortic Aneurysm (rAAA)...
...erring Hospital Checklist for the...
...iving Hospital Personnel Alert Checklist for Manag...
...ice Of Anesthetic Technique And Agent...
...SVS recommends general endotracheal...
...tibiotic Prophyla...
...he SVS recommends intravenous administra...
...e SVS recommends that any potential sources of de...
...traoperative Fluid Resuscitation And Bloo...
...recommends using cell salvage or an...
...traoperative hemoglobin level is...
...diovascular Monitorin...
...S suggests using pulmonary artery...
...ecommends central venous access and arte...
...commends postoperative ST-segment monitori...
...SVS recommends postoperative troponin measurement...
...e of Body Temperature...
...he SVS recommends maintaining core body...
...e of the ICU
...SVS recommends postoperative management in an...
...sogastric Decompression And Perioperative Nutr...
...mmends optimization of preoperative nu...
...mends using nasogastric decompress...
...nds parenteral nutrition if a patient is unable...
...is For Deep Venous Thrombosis...
...recommends thromboprophylaxis that inc...
The SVS suggests thromboprophylaxis...
...stoperative Blood Transfusion...
...e of ongoing blood loss, the SVS suggests a thr...
...rative Pain Management...
...e SVS recommends multimodality treatment, incl...
Late Outcom...
...mmends treatment of type I endoleaks. (See...
...treatment of type II endoleaks associated wi...
...he SVS recommends surveillance of type II...
...mmends treatment of type III endoleaks. ( 1 – St...
...he SVS suggests no treatment of type IV en...
...mends open repair if endovascular...
...suggests open repair if endovascular interventio...
...he SVS suggests treatment for ongoin...
...mends that follow-up of patients after...
...mends a prompt evaluation for possible g...
...S recommends antibiotic prophylaxis...
...S suggests antibiotic prophylaxis...
...repair, the SVS recommends prompt evaluation f...
...mends prompt evaluation for possible aortoente...
...enting with an infected graft in the prese...
...n patients presenting with an infected...
...ble patient presenting with an infected graft, t...
In unstable patients with infected graf...
...ecommendation For Postoperative Sur...
...ecommends baseline imaging in the first mon...
...I endoleak is observed 1 month after...
...doleak nor AAA enlargement is observed 1 y...
...oleak is associated with an aneurysm...
...endoleak is detected, the SVS suggests evaluat...
...e SVS suggests non-contrast-enhanced CT imagin...
...oleaksHaving trouble viewing table? Expand...