Cardiology Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

June 28, 2018

In This Article

Abdominal Aortic Aneurysm

Society for Vascular Surgery

Surveillance imaging at 12-month intervals is recommended for patients with an AAA of 4.0 to 4.9 cm in diameter.

Recommend performing physical examination that includes an assessment of femoral and popliteal arteries.

Endovascular repair is recommended as the preferred method of treatment for ruptured aneurysms.

Incorporating knowledge gained through the Vascular Quality Initiative and other regional quality collaboratives, it is suggested that the Vascular Quality Initiative mortality risk score be used for mutual decision-making with patients considering aneurysm repair.

It is suggested that elective endovascular aneurysm repair (EVAR) be limited to hospitals with a documented mortality and conversion rate to open surgical repair of 2% or less and that perform at least 10 EVAR cases each year.

It is suggested that elective open aneurysm repair be limited to hospitals with a documented mortality of 5% or less and that perform at least 10 open aortic operations of any type each year.

To encourage the development of effective systems of care that would lead to improved outcomes for those patients undergoing emergent repair, a door-to-intervention time of <90 minutes, based on a framework of 30-30-30 minutes, is suggested for the management of the patient with a ruptured aneurysm.

Recommend treatment of type I and III endoleaks as well as of type II endoleaks with aneurysm expansion but recommend continued surveillance of type II endoleaks not associated with aneurysm expansion.

Whereas antibiotic prophylaxis is recommended for patients with an aortic prosthesis before any dental procedure involving the manipulation of the gingival or periapical region of teeth or perforation of the oral mucosa, antibiotic prophylaxis is not recommended before respiratory tract procedures, gastrointestinal or genitourinary procedures, and dermatologic or musculoskeletal procedures unless the potential for infection exists or the patient is immunocompromised.

Increased utilization of color duplex ultrasound is suggested for postoperative surveillance after EVAR in the absence of endoleak or aneurysm expansion.

Recommend a preoperative resting 12-lead electrocardiogram (ECG) in all patients undergoing EVAR or open surgical repair (OSR) within 30 days of planned treatment.

Suggest deferring open aneurysm repair for at least 6 months after drug-eluting coronary stent placement or, alternatively, performing EVAR with continuation of dual antiplatelet therapy.

Perioperative transfusion of packed red blood cells are recommended if the hemoglobin level is <7 g/dL.

Recommend elective repair for the patient at low or acceptable surgical risk with a fusiform AAA that is ≥5.5 cm.

General endotracheal anesthesia is recommended for patients undergoing open aneurysm repair.

Reference

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