SVS Guidelines Bundle

Abdominal Aortic Aneurysm

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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)

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