Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery

Abstract

These guidelines refer to the management of elective infra-renal AAA onlye for cases that are amenable to treatment by a standard, commercially available endograft, or by open repair utilising an infra-renal aortic clamp placement. Cases that will require the use of branched/ fenestrated endografts, a suprarenal aortic clamp, suprarenal aneurysms and thoraco-abdominal aneurysms should be referred to units specialising in the treatment of these more complex, higher-risk cases.

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

“…AAA diameter has long since also been acknowledged as a risk factor for aneurysm rupture and is used as an indicator for elective repair surgery 2, 3. Our results are in line with this common use, although 3 of 9 studies found no differences between ruptured AAA versus patients preceding elective repair.…”

“…AAA diameter is broadly accepted as a predictive factor for both aneurysm growth and rupture and is thus implemented in important AAA follow‐up guidelines 2, 3. Our systematic review confirmed the strong prognostic value for expansion given that 8 of 9 studies had significant outcomes, with mainly low bias risks and low P values in a total of 1503 patients.…”

“…Such an event can be prevented by surgical AAA repair. The decision to perform surgery is commonly based on 3 characteristics being the: (1) maximum AAA diameter exceeding 5.0 cm in women and 5.5 cm in men; (2) experience of symptoms; or (3) aneurysm growth rate exceeds 1 cm/year 2, 3. The first 2 characteristics are relatively easy to identify by imaging or by questioning the patient.…”

Tratamento endovascular do aneurisma aortoilíaco: relato do primeiro caso utilizando endoprótese brasileira com ramo ilíaco

“…16 The current tendency is to preserve pelvic flow when treating aortoiliac aneurysms, even when internal iliac arteries are involved, and specific directives for management and treatment of aneurysmal aortoiliac disease suggest that at least one internal iliac branch should be preserved. 17,18 Studies have been published showing good results in terms of preservation of flow to an iliac branch and reporting technical success and low morbidity with the procedure. 10,11,19,20 The majority of significant complications described after implantation of these devices are related to acute occlusion of the iliac branch.…”

Giant abdominal aortic aneurysm

“…A larger initial aneurysm diameter is a significant and independent risk factor for AAA rupture: the 12-month rupture risk is about 30-33% for AAAs > 7.0 cm in size. 2 Patients with giant AAAs require urgent treatment. Open surgical repair is often the only viable treatment because aneurysm size implicates an adverse neck anatomy that makes these AAAs not suitable for endovascular aneurysm repair.…”