Diagnosis
4
➤ The SVS suggests deferring elective aneurysm repair for 30 days
after bare-metal stent placement or coronary artery bypass surgery
if clinical circumstances permit. As an alternative, EVAR may be
performed with uninterrupted continuation of dual antiplatelet
therapy. (2-B)
➤ The SVS suggests deferring open aneurysm repair for ≥6 months after
drug-eluting coronary stent placement or, alternatively, performing
EVAR with continuation of dual antiplatelet therapy. (2-B)
➤ In patients with a drug-eluting coronary stent requiring open
aneurysm repair, the SVS recommends discontinuation of P2Y12
platelet receptor inhibitor therapy 10 days preoperatively with
continuation of aspirin. The P2Y12 inhibitor should be restarted as
soon as possible after surgery. The relative risks and benefits of
perioperative bleeding and stent thrombosis should be discussed with
the patient. (1-B)
➤ The SVS suggests continuation of beta blocker therapy during the
perioperative period if it is part of an established medical regimen.
(2-B)
➤ If a decision was made to start beta blocker therapy (because of the
presence of multiple risk factors, such as coronary artery disease,
renal insufficiency, and diabetes), the SVS suggests initiation well
in advance of surgery to allow sufficient time to assess safety and
tolerability. (2-B)
➤ The SVS suggests preoperative pulmonary function studies, including
room air arterial blood gas determinations, in patients with a history
of symptomatic chronic obstructive pulmonary disease (COPD), long-
standing tobacco use, or inability to climb one flight of stairs. (2-C)
➤ The SVS recommends smoking cessation for ≥2 weeks before
aneurysm repair. (1-C)
➤ The SVS suggests administration of pulmonary bronchodilators for
at least 2 weeks before aneurysm repair in patients with a history of
COPD or abnormal results of pulmonary function testing. (2-C)
➤ The SVS suggests holding angiotensin-converting enzyme (ACE)
inhibitors and angiotensin receptor antagonists on the morning
of surgery and restarting these agents after the procedure once
euvolemia has been achieved. (2-C)
➤ The SVS recommends preoperative hydration in non-dialysis–
dependent patients with renal insufficiency before aneurysm repair.
(1-A)
