3
Diagnosis
Physical Examination
➤ In patients with a suspected or known abdominal aortic aneurysm
(AAA), the SVS recommends performing physical examination that
includes an assessment of femoral and popliteal arteries. (1-A)
➤ In patients with a popliteal or femoral artery aneurysm, the SVS
recommends evaluation for an AAA. (1-A)
Assessment of Medical Comorbidities
➤ In patients with active cardiac conditions, including unstable angina,
decompensated heart failure, severe valvular disease, and significant
arrhythmia, the SVS recommends cardiology consultation before
EVAR or open surgical repair (OSR). (1-B)
➤ In patients with significant clinical risk factors, such as coronary
artery disease, congestive heart failure, cerebrovascular disease,
diabetes mellitus, chronic renal insufficiency, and unknown or poor
functional capacity (metabolic equivalent [MET] <4), who are to
undergo OSR or EVAR, the SVS suggests noninvasive stress testing.
(2-B)
➤ The SVS recommends a preoperative resting 12-lead
electrocardiogram (ECG) in all patients undergoing EVAR or OSR
within 30 days of planned treatment. (1-B)
➤ The SVS recommends echocardiography before planned operative
repair in patients with dyspnea of unknown origin or worsening
dyspnea. (1-A)
➤ The SVS suggests coronary revascularization before aneurysm repair
in patients with acute ST-segment or non-ST–segment elevation
myocardial infarction (MI), unstable angina, or stable angina with left
main coronary artery or three-vessel disease. (2-B)
➤ The SVS suggests coronary revascularization before aneurysm
repair in patients with stable angina and two-vessel disease that
includes the proximal left descending artery and either ischemia
on noninvasive stress testing or reduced left ventricular function
(ejection fraction <50%). (2-B)
➤ In patients who may need aneurysm repair in the subsequent 12
months and in whom percutaneous coronary intervention is indicated,
the SVS suggests a strategy of balloon angioplasty or bare-metal
stent placement, followed by 4–6 weeks of dual antiplatelet therapy.
(2-B)