SVS Guidelines Bundle

Abdominal Aortic Aneurysm

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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)

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