SVS Guidelines Bundle

Abdominal Aortic Aneurysm

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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)

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