Treatment
20
Role of the ICU
➤ The SVS recommends postoperative management in an ICU for the
patient with significant cardiac, pulmonary, or renal disease as well
as for those requiring postoperative mechanical ventilation or who
developed a significant arrhythmia or hemodynamic instability during
operative treatment. (1-A)
Nasogastric Decompression And Perioperative Nutrition
➤ The SVS recommends optimization of preoperative nutritional status
before elective open aneurysm repair if repair will not be unduly
delayed. (1-A)
➤ The SVS recommends using nasogastric decompression intraoperatively
for all patients undergoing open aneurysm repair but postoperatively
only for those patients with nausea and abdominal distention. (1-A)
➤ The SVS recommends parenteral nutrition if a patient is unable to
tolerate enteral support 7 days after aneurysm repair. (1-A)
Prophylaxis For Deep Venous Thrombosis
➤ The SVS recommends thromboprophylaxis that includes intermittent
pneumatic compression and early ambulation for all patients
undergoing OSR or EVAR. (1-A)
➤ The SVS suggests thromboprophylaxis with unfractionated or low-
molecular-weight heparin for patients undergoing aneurysm repair at
moderate to high risk for venous thromboembolism and low risk for
bleeding. (2-C)
Postoperative Blood Transfusion
➤ In the absence of ongoing blood loss, the SVS suggests a threshold
for blood transfusion during or after aneurysm repair at a hemoglobin
concentration of ≤7 g/dL. (2-C)
Perioperative Pain Management
➤ The SVS recommends multimodality treatment, including epidural
analgesia, for postoperative pain control after OSR of an AAA. (1-A)