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
...iagnosis...
...sical Examinat...
...patients with a suspected or known abdominal aorti...
...atients with a popliteal or femoral artery an...
...ssessment of Medical Comorbid...
...n patients with active cardiac condit...
...atients with significant clinical risk factors,...
...mmends a preoperative resting 12-le...
...SVS recommends echocardiography before planned...
...SVS suggests coronary revasculariz...
...VS suggests coronary revascularization before ane...
...atients who may need aneurysm repair in the subs...
The SVS suggests deferring elective aneury...
...ggests deferring open aneurysm repair for ≥6 mon...
...ents with a drug-eluting coronary stent r...
...sts continuation of beta blocker therapy dur...
...s made to start beta blocker therapy (becau...
The SVS suggests preoperative pulmonary function...
...ecommends smoking cessation for ≥...
...ts administration of pulmonary bronc...
The SVS suggests holding angiotensi...
...recommends preoperative hydration in...
...e SVS recommends preprocedure and postprocedur...
...ommends holding metformin at the time of administr...
...ends restarting metformin no sooner...
...nds perioperative transfusion of pa...
...s hematologic assessment if the preoperative pl...
...eoperative Cardiac Evaluation for the Pat...
...unctional Capacity Estimation From an Ass...
...eurysm Imagin...
...mends using ultrasound, when feasible, as the...
...e SVS suggests that the maximum ane...
...SVS recommends a one-time ultrasound screeni...
...ts ultrasound screening for AAA in first degree r...
...suggests a one-time ultrasound screening...
...tial ultrasound screening identified an...
...ts surveillance imaging at 3-year inte...
...VS suggests surveillance imaging at...
...uggests surveillance imaging at 6-m...
...ends a CT scan to evaluate patients...
Treatment
Treatme...
...e Decision to Tre...
...sts referral to a vascular surgeon at the time o...
...nds repair for the patient who presents w...
...recommends elective repair for the p...
...he SVS suggests elective repair for the patient...
...sts repair in women with AAA 5.0–5.4 cm i...
...a small aneurysm (4.0–5.4 cm) who wil...
...anagement During the Period of AAA Surveillance...
...ommends smoking cessation to reduce...
...VS suggests NOT administering statins, doxycycli...
...ests NOT administering beta blocker therap...
...for Intervention...
...mends immediate repair for patient...
...hould repair of a symptomatic AAA be dela...
...ent of Operative Risk and Life Expectancy...
...S suggests informing patients contemplati...
...ity Risk Scoring Scheme for Patients Undergoing...
...able 3b. Risk Categorization Based on Mortality Ri...
...VAR...
...S recommends preservation of flow to at le...
...e SVS recommends using Food and Drug Adminis...
...recommends staging bilateral internal il...
...gests renal artery or superior mesenteric ar...
...ts prophylactic treatment of an as...
...sts preservation of accessory renal ar...
Perioperative Outcomes of Elective EVAR
...gests that elective EVAR be performed at centers...
...tive EVAR in the High-Risk and Unfit Pa...
...s informing high-risk patients of their...
...SR...
...VS recommends a retroperitoneal approach for pa...
...a retroperitoneal exposure or a tr...
...recommends a thrombin inhibitor, such as b...
...S recommends straight tube grafts for OS...
...he SVS recommends performing the pr...
...nds that all portions of an aortic graft...
...ends reimplantation of a patent IMA under cir...
...ommends preserving blood flow to a...
...ts concomitant surgical treatment of other visc...
...he SVS suggests concomitant surgica...
...e 4. Surgical Approaches for Open Aneurys...
...erioperative Outcomes of Open...
...SVS suggests that elective OSR for AAA be perfor...
...stimated Perioperative Complications After...
...Patient with a Ruptured Aneurysm
...ests a door-to-intervention time of...
...protocol for the management of ruptured AAA is ess...
...ds implementing hypotensive hemostasi...
...he SVS suggests that patients with ruptur...
...anatomically feasible, the SVS recommends EVAR ov...
...Suspected Ruptured Abdominal Aortic...
...rring Hospital Checklist for the Pati...
Table 7. Receiving Hospital Personnel Alert C...
...nesthetic Technique And Age...
...ommends general endotracheal anesthesia fo...
Antibiotic Prophylax...
...ecommends intravenous administration of a first-g...
...nds that any potential sources of denta...
...rative Fluid Resuscitation And Blood...
...S recommends using cell salvage or...
...intraoperative hemoglobin level is...
...ascular Monitoring...
The SVS suggests using pulmonary art...
...ds central venous access and arterial line monito...
...commends postoperative ST-segment moni...
...commends postoperative troponin measurement for...
...e of Body Temperature
The SVS recommends maintaining core b...
Role of the...
...mends postoperative management in an ICU f...
...ompression And Perioperative Nutrition...
...ecommends optimization of preoperative nutrition...
...recommends using nasogastric decompression...
...ommends parenteral nutrition if a p...
...ophylaxis For Deep Venous Thromb...
...recommends thromboprophylaxis that inclu...
...ests thromboprophylaxis with unfraction...
...operative Blood Transfusion...
...nce of ongoing blood loss, the SVS su...
...tive Pain Management...
The SVS recommends multimodality treatment,...
...ate Outcomes
...SVS recommends treatment of type I en...
The SVS suggests treatment of type II endoleak...
...SVS recommends surveillance of type II en...
...nds treatment of type III endoleaks. ( 1 –...
...suggests no treatment of type IV endoleaks. (...
...nds open repair if endovascular intervention...
...suggests open repair if endovascula...
...SVS suggests treatment for ongoing an...
...SVS recommends that follow-up of patients aft...
...ends a prompt evaluation for possible...
...ds antibiotic prophylaxis to prevent graft i...
...SVS suggests antibiotic prophylaxis before...
...urysm repair, the SVS recommends prompt evaluatio...
...S recommends prompt evaluation for pos...
...ts presenting with an infected graft in the p...
...atients presenting with an infected graf...
...stable patient presenting with an infected graft,...
...able patients with infected graft, th...
...dation For Postoperative Surveilla...
...SVS recommends baseline imaging in th...
...oleak is observed 1 month after EVAR, the SVS...
...doleak nor AAA enlargement is observed 1 ye...
...oleak is associated with an aneurys...
...oleak is detected, the SVS suggests evaluation for...
The SVS suggests non-contrast-enhanced CT imaging...
...le 8. EndoleaksHaving trouble view...