Key Points
2
➤ Aneurysms present with varying risks of rupture, and patient-specific
factors influence anticipated life expectancy, operative risk, and need
to intervene. Careful attention to the choice of operative strategy
along with optimal treatment of medical comorbidities is critical to
achieving excellent outcomes.
➤ The SVS recommends endovascular repair as the preferred method of
treatment for ruptured aneurysms.
➤ The SVS suggests that the Vascular Quality Initiative mortality risk
score (https://qxmd.com/calculate/calculator_322/vascular-quality-
initiative-vqi-cardiac-risk-index-cri-evar) be used for mutual decision-
making with patients considering aneurysm repair.
➤ The SVS also suggest that elective endovascular aneurysm repair
(EVAR) be limited to hospitals with a documented mortality and
conversion rate to open surgical repair of ≤2% and that perform ≥10
EVAR cases each year. The SVS also suggests that elective open
aneurysm repair be limited to hospitals with a documented mortality
of ≤5% and that perform ≥10 open aortic operations of any type each
year.
➤ The SVS suggests a door-to-intervention time of <90 minutes, based
on a framework of 30-30-30 minutes, for the management of the
patient with a ruptured aneurysm.
➤ The SVS recommends treatment of type I and III endoleaks as well
as of type II endoleaks with aneurysm expansion but recommend
continued surveillance of type II endoleaks not associated with
aneurysm expansion.
➤ Whereas antibiotic prophylaxis is recommended for patients
with an aortic prosthesis before any dental procedure involving
the manipulation of the gingival or periapical region of teeth
or perforation of the oral mucosa, antibiotic prophylaxis is not
recommended before respiratory tract procedures, gastrointestinal
or genitourinary procedures, and dermatologic or musculoskeletal
procedures unless the potential for infection exists or the patient is
immunocompromised.
➤ Increased utilization of color duplex ultrasound is suggested for
postoperative surveillance after EVAR in the absence of endoleak or
aneurysm expansion.
