9
Treatment
The Decision to Treat
➤ The SVS suggests referral to a vascular surgeon at the time of initial
diagnosis of an aortic aneurysm. (G-U)
➤ The SVS recommends repair for the patient who presents with an
AAA and abdominal or back pain that is likely to be attributed to the
aneurysm. (1-C)
➤ The SVS recommends elective repair for the patient at low or
acceptable surgical risk with a fusiform AAA that is ≥5.5 cm. (1-A)
➤ The SVS suggests elective repair for the patient who presents with a
saccular aneurysm. (2-C)
➤ The SVS suggests repair in women with AAA 5.0–5.4 cm in maximum
diameter. (2-B)
➤ In patients with a small aneurysm (4.0–5.4 cm) who will require
chemotherapy, radiation therapy, or solid organ transplantation, the
SVS suggests a shared decision-making approach to decide about
treatment options. (2-C)
Medical Management During the Period of AAA Surveillance
➤ The SVS recommends smoking cessation to reduce the risk of AAA
growth and rupture. (1-B)
➤ The SVS suggests NOT administering statins, doxycycline,
roxithromycin, ACE inhibitors, or angiotensin receptor blockers for the
sole purpose of reducing the risk of AAA expansion and rupture. (2-C)
➤ The SVS suggests NOT administering beta blocker therapy for the
sole purpose of reducing the risk of AAA expansion and rupture. (1-B)
Timing for Intervention
➤ The SVS recommends immediate repair for patients who present with
a ruptured aneurysm. (1-A)
➤ Should repair of a symptomatic AAA be delayed to optimize coexisting
medical conditions, the SVS recommends that the patient be
monitored in an intensive care unit (ICU) setting with blood products
available. (1-C)
Assessment of Operative Risk and Life Expectancy
➤ The SVS suggests informing patients contemplating open repair or
EVAR of their Vascular Quality Initiative (VQI) perioperative mortality
risk score (https://qxmd.com/calculate/calculator_324/vascular-
quality-initiative-vqi-cardiac-risk-index-cri-open-aaa-repair & https://
qxmd.com/calculate/calculator_284/vsgne-ruptured-abdominal-aortic-
aneurysm-raaa-risk-score). (2-C)
