The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Abstract

DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

Vascular imaging with positron emission tomography

“…Recent studies have extended this work into the area of abdominal aortic aneurysm, to determine whether inflammation might be a predictor of rapid aneurysm expansion or heightened rupture risk. Current guidelines for stable patients recommend surgical or endovascular intervention based largely on aortic dimensions [82,83], although it is well known that rupture can occur in small aneurysms as well. It has been shown that abdominal aortic FDG uptake is associated with higher wall stress [84] and correlates with instability, symptoms and with macrophage infiltration [85].…”

Successful management of critical iliac artery aneurysm which is unexpectedly accompanied by acute aortic dissection type B: A case report

“…Abdominal Aortic Aneurysm (AAA) is the most common form of aortic aneurysms that results from degradation of medial elastin of the atheromatous aorta 11, 12…”

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.…”