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

...al Examination...

...with a suspected or known abdominal aortic an...

...th a popliteal or femoral artery aneur...


...of Medical Comorbidities...

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

In patients with significant clinical risk fa...

The SVS recommends a preoperative re...

...recommends echocardiography before plan...

...sts coronary revascularization before...

...gests coronary revascularization b...

...ts who may need aneurysm repair in the subsequent...

...suggests deferring elective aneurysm...

...e SVS suggests deferring open aneurysm re...

...patients with a drug-eluting coronary stent requi...

...ts continuation of beta blocker the...

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

...sts preoperative pulmonary functio...

...ecommends smoking cessation for ≥...

...VS suggests administration of pulmo...

...SVS suggests holding angiotensin-con...

...ends preoperative hydration in non-dialysisâ...

...nds preprocedure and postprocedure hydr...

...S recommends holding metformin at the...

...SVS recommends restarting metformin...

...commends perioperative transfusion of packed r...

...SVS suggests hematologic assessment if the...


...eoperative Cardiac Evaluation for the Patient...


...2. Functional Capacity Estimation From an Assess...


Aneurysm Im...

...recommends using ultrasound, when fea...

...S suggests that the maximum aneurysm diameter...

...he SVS recommends a one-time ultrasound scree...

...VS suggests ultrasound screening for AAA in...

...ests a one-time ultrasound screening for A...

...tial ultrasound screening identified...

...S suggests surveillance imaging at 3-year interval...

...VS suggests surveillance imaging at 12-mo...

...surveillance imaging at 6-month intervals for p...

The SVS recommends a CT scan to evaluate pati...


Treatment

...reatme...

The Decision to...

...sts referral to a vascular surgeon at t...

...S recommends repair for the patient who pr...

...VS recommends elective repair for the patien...

...ests elective repair for the patient who pr...

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

...patients with a small aneurysm (4.0â€...


...ment During the Period of AAA Surveil...

...ecommends smoking cessation to reduce the risk of...

...suggests NOT administering statins, dox...

...SVS suggests NOT administering beta bloc...


...ing for Interventi...

The SVS recommends immediate repair for patients...

...ld repair of a symptomatic AAA be delayed to...


...nt of Operative Risk and Life Expectancy...

...suggests informing patients contempla...


...a. Mortality Risk Scoring Scheme for Patien...


...k Categorization Based on Mortalit...


EVA...

...S recommends preservation of flow to at...

...ds using Food and Drug Administration (FDA)...

...e SVS recommends staging bilateral in...

...gests renal artery or superior mesenteric...

...gests prophylactic treatment of an asymptom...

The SVS suggests preservation of accessory renal...

...perative Outcomes of Elective EVAR

...gests that elective EVAR be performed at cen...

...ole of Elective EVAR in the High-Risk and Unf...

...e SVS suggests informing high-risk patient...


OS...

...commends a retroperitoneal approach for patient...

The SVS suggests a retroperitoneal expos...

...e SVS recommends a thrombin inhibitor...

...ommends straight tube grafts for OSR of AAA...

...ds performing the proximal aortic anastomosi...

...mends that all portions of an aortic gr...

...VS recommends reimplantation of a pat...

...ds preserving blood flow to at least one hypog...

...SVS suggests concomitant surgical trea...

...sts concomitant surgical repair of an AAA and coe...


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


...Outcomes of Open AAA Repair...

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

...Estimated Perioperative Complications Afte...


...nt with a Ruptured Aneurysm...

...suggests a door-to-intervention time o...

...ablished protocol for the management...

...recommends implementing hypotensive h...

...ts that patients with ruptured AAA...

...omically feasible, the SVS recommends EV...

...1. Suspected Ruptured Abdominal Aortic An...

...ferring Hospital Checklist for the Patient Wi...

...iving Hospital Personnel Alert Chec...


...ice Of Anesthetic Technique...

The SVS recommends general endotrac...


...iotic Prophylaxis...

...e SVS recommends intravenous administration of...

...nds that any potential sources of dental sepsis...


...e Fluid Resuscitation And Blood Con...

...ecommends using cell salvage or an ultrafiltrati...

If the intraoperative hemogl...


...iovascular Monitoring

...sts using pulmonary artery catheters only if th...

...VS recommends central venous access an...

...SVS recommends postoperative ST-segment...

...recommends postoperative troponin measurement for...


...enance of Body Temperatur...

...S recommends maintaining core body temperatu...


...ole of the IC...

...SVS recommends postoperative management...


...astric Decompression And Perioperative N...

...SVS recommends optimization of preoperati...

...mmends using nasogastric decompression i...

...ends parenteral nutrition if a patient is una...


...is For Deep Venous Thrombosis...

The SVS recommends thromboprophylaxis th...

...uggests thromboprophylaxis with unfrac...


...ive Blood Transfusion...

...of ongoing blood loss, the SVS suggests a thres...


...erioperative Pain Mana...

...S recommends multimodality treatment, includi...


...te Outcomes

...mends treatment of type I endoleaks. (...

...uggests treatment of type II endole...

...ommends surveillance of type II endoleaks not a...

...mmends treatment of type III endoleak...

...sts no treatment of type IV endoleak...

...SVS recommends open repair if endov...

...ests open repair if endovascular i...

...uggests treatment for ongoing aneurysm e...

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

...mmends a prompt evaluation for poss...

...nds antibiotic prophylaxis to prevent graft inf...

...ts antibiotic prophylaxis before respir...

...ysm repair, the SVS recommends prompt evaluation f...

...ecommends prompt evaluation for possib...

...nts presenting with an infected graft...

...resenting with an infected graft with minima...

In a stable patient presenting with an inf...

In unstable patients with infected graft,...


...endation For Postoperative Surv...

...e SVS recommends baseline imaging in...

...endoleak is observed 1 month after EVAR, the SV...

...leak nor AAA enlargement is observed 1 yea...

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

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

...S suggests non-contrast-enhanced CT imagi...


...EndoleaksHaving trouble viewing table? Expand...