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
...cal Examination...
...atients with a suspected or known abdominal a...
...h a popliteal or femoral artery an...
Assessment of Medical Comorbi...
...n patients with active cardiac conditions,...
...with significant clinical risk fa...
...VS recommends a preoperative resting 12-lead e...
...recommends echocardiography before p...
...he SVS suggests coronary revascularization befor...
...suggests coronary revascularization be...
...who may need aneurysm repair in the subsequent...
...s deferring elective aneurysm repair for 30 da...
...VS suggests deferring open aneurysm repair for â...
In patients with a drug-eluting coron...
...e SVS suggests continuation of beta b...
...ion was made to start beta blocker thera...
...preoperative pulmonary function stu...
The SVS recommends smoking cessation...
The SVS suggests administration of pul...
...holding angiotensin-converting en...
...ommends preoperative hydration in non-dialysisâ...
...ecommends preprocedure and postprocedure...
...nds holding metformin at the time of admini...
...commends restarting metformin no sooner th...
...ds perioperative transfusion of pac...
...SVS suggests hematologic assessment...
...Preoperative Cardiac Evaluation for the Patient U...
...ional Capacity Estimation From an Assess...
...ysm Imaging
...ends using ultrasound, when feasible, as the pr...
The SVS suggests that the maximum a...
...recommends a one-time ultrasound s...
...SVS suggests ultrasound screening for AAA i...
...SVS suggests a one-time ultrasound screenin...
...sound screening identified an aortic...
...ggests surveillance imaging at 3-yea...
The SVS suggests surveillance imaging at 12-mo...
...s surveillance imaging at 6-month intervals for pa...
...nds a CT scan to evaluate patients thought to hav...
Treatment
...eatment...
...Decision to Treat...
...SVS suggests referral to a vascular su...
...ommends repair for the patient who pr...
The SVS recommends elective repair for the patient...
...elective repair for the patient who presents...
...gests repair in women with AAA 5.0–5.4 cm in ma...
...atients with a small aneurysm (4.0–5.4 cm) w...
...cal Management During the Period of AAA...
...nds smoking cessation to reduce the r...
...ests NOT administering statins, doxyc...
...he SVS suggests NOT administering be...
...for Intervention...
...ds immediate repair for patients who present w...
...air of a symptomatic AAA be delayed to o...
...nt of Operative Risk and Life Expectancy...
...informing patients contemplating op...
...Mortality Risk Scoring Scheme for Patients...
.... Risk Categorization Based on Mortal...
EVAR
...ds preservation of flow to at least one i...
...mends using Food and Drug Administration...
...ommends staging bilateral internal...
...he SVS suggests renal artery or superior mes...
...VS suggests prophylactic treatment of an...
...ests preservation of accessory renal arterie...
...ve Outcomes of Elective EVAR...
...ts that elective EVAR be performed at c...
...e EVAR in the High-Risk and Unfit Patient...
...VS suggests informing high-risk patients...
...SR...
...VS recommends a retroperitoneal approach for pati...
...s a retroperitoneal exposure or a...
The SVS recommends a thrombin inhibitor,...
...recommends straight tube grafts for OSR of AAA in...
...ommends performing the proximal aortic ana...
...ommends that all portions of an aortic...
...commends reimplantation of a patent IMA under cir...
...ends preserving blood flow to at least one hypoga...
...suggests concomitant surgical treatmen...
...he SVS suggests concomitant surgic...
...Surgical Approaches for Open Aneurysm R...
Perioperative Outcomes of Op...
...he SVS suggests that elective OSR for AAA be per...
...ated Perioperative Complications After Electi...
The Patient with a Ruptured Aneu...
...gests a door-to-intervention time of...
An established protocol for the managem...
...e SVS recommends implementing hypotensive he...
...suggests that patients with ruptured...
...ically feasible, the SVS recommends EVAR over...
...igure 1. Suspected Ruptured Abdominal Aortic A...
...rring Hospital Checklist for the P...
...e 7. Receiving Hospital Personnel Alert Checklist...
...Of Anesthetic Technique And Agent...
...SVS recommends general endotracheal anesthes...
...biotic Prophylax...
...S recommends intravenous administr...
...mmends that any potential sources of dental...
...traoperative Fluid Resuscitation And Blood Conser...
...S recommends using cell salvage or an ult...
...intraoperative hemoglobin level is...
...ovascular Monitoring...
...SVS suggests using pulmonary arte...
...commends central venous access and...
...recommends postoperative ST-segment m...
...ommends postoperative troponin measurement for all...
...nance of Body Temperature...
...ends maintaining core body temperature ≥3...
Role of the...
...ecommends postoperative management...
...asogastric Decompression And Periop...
...commends optimization of preoperative nutritional...
...commends using nasogastric decompression intraop...
...S recommends parenteral nutrition...
...For Deep Venous Thrombosis...
...he SVS recommends thromboprophylaxis that i...
...S suggests thromboprophylaxis with...
...ostoperative Blood Tr...
...of ongoing blood loss, the SVS suggests a thre...
...rative Pain Manageme...
...ecommends multimodality treatment, incl...
Late Outc...
...nds treatment of type I endoleaks....
...gests treatment of type II endoleaks...
The SVS recommends surveillance of type II endo...
...ds treatment of type III endoleaks. (...
...SVS suggests no treatment of type IV e...
...S recommends open repair if endovascular i...
...suggests open repair if endovascular...
...SVS suggests treatment for ongoing aneurysm expa...
...ds that follow-up of patients after aneurysm repai...
...ends a prompt evaluation for possible...
...S recommends antibiotic prophylaxis to prevent gr...
...gests antibiotic prophylaxis before respirato...
...m repair, the SVS recommends prompt...
...he SVS recommends prompt evaluation for...
...presenting with an infected graft in t...
...ts presenting with an infected graft with minim...
...ient presenting with an infected graft, th...
...patients with infected graft, the SVS recom...
...commendation For Postoperative Surveill...
...ommends baseline imaging in the first month after...
...doleak is observed 1 month after EVAR, t...
...doleak nor AAA enlargement is observ...
If a type II endoleak is associated with...
...k is detected, the SVS suggests evaluatio...
...non-contrast-enhanced CT imaging of the enti...
...eaksHaving trouble viewing table?...