Treatment
12
EVAR
➤ The SVS recommends preservation of flow to at least one internal
iliac artery. (1-A)
➤ The SVS recommends using Food and Drug Administration (FDA)-
approved branch endograft devices in anatomically suitable patients
to maintain perfusion to at least one internal iliac artery. (1-A)
➤ The SVS recommends staging bilateral internal iliac artery occlusion
by ≥1–2 weeks if required for EVAR. (1-A)
➤ The SVS suggests renal artery or superior mesenteric artery (SMA)
angioplasty and stenting for selected patients with symptomatic
disease before EVAR or OSR. (2-C)
➤ The SVS suggests prophylactic treatment of an asymptomatic,
high-grade stenosis of the SMA in the presence of a meandering
mesenteric artery based off of a large inferior mesenteric artery
(IMA), which will be sacrificed during the course of treatment. (2-C)
➤ The SVS suggests preservation of accessory renal arteries at the time
of EVAR or OSR if the artery is ≥3 mm in diameter or supplies more
than one-third of the renal parenchyma. (2-C)
Perioperative Outcomes of Elective EVAR
➤ The SVS suggests that elective EVAR be performed at centers with a
volume of ≥10 EVAR cases each year and a documented perioperative
mortality and conversion rate to OSR of ≤2%. (2-C)
Role of Elective EVAR in the High-Risk and Unfit Patient
➤ The SVS suggests informing high-risk patients of their VQI
perioperative mortality risk score to make an informed decision to
proceed with aneurysm repair. (2-C)
OSR
➤ The SVS recommends a retroperitoneal approach for patients
requiring OSR of an inflammatory aneurysm, a horseshoe kidney, or
an aortic aneurysm in the presence of a hostile abdomen. (1-C)
➤ The SVS suggests a retroperitoneal exposure or a transperitoneal
approach with a transverse abdominal incision for patients with
significant pulmonary disease requiring OSR. (2-C)
➤ The SVS recommends a thrombin inhibitor, such as bivalirudin or
argatroban, as an alternative to heparin for patients with a history of
heparin-induced thrombocytopenia. (1-B)
