European Society for Vascular Surgery (ESVS) 2019 Clinical ...

1 European Society for Vascular Surgery (ESVS) 2019 Clinical PracticeGuidelines on the Management of Abdominal Aorto-iliac Artery AneurysmsAnders Wanhainena,y,*, Fabio Verzinia,y, Isabelle Van Herzeelea, Eric Allairea, Matthew Bowna, Tina Cohnerta, Florian Dicka,Joost van Herwaardena, Christos Karkosa, Mark Koelemaya, Tilo K lbela, Ian Loftusa, Kevin Mania, Germano Melissanoa,Janet Powella, Zolt n SzeberinaESVS Guidelines Committeeb, Gert J. de Borst, Nabil Chakfe, Sebastian Debus, Rob Hinchliffe, Stavros Kakkos, Igor Koncar,Philippe Kolh, Jes Lindholdt, Melina de Vega, Frank VermassenDocument reviewersc, Martin Bj rck, Stephen Cheng, Ronald Dalman, Lazar Davidovic, Konstantinos Donas, Jonothan Earnshaw,Hans-Henning Eckstein, Jonathan Golledge, Stephan Haulon, Tara Mastracci, Ross Naylor, Jean-Baptiste Ricco, Hence VerhagenTABLE OF CONTENTSList of abbreviations.

2 41. Introduction and General Aspects .. Introduction and methods .. The purpose of these .. Strategy .. Literature search and Weighing the evidence .. The patient s perspective .. Service standards .. Quality control .. Resources and availability .. Surgical volume .. Pathway for treatment ..82. Epidemiology, Diagnosis, and .. Epidemiology .. Definition of abdominal aortic aneurysms .. Suggested reporting standards for AAA .. Prevalence of AAA .. Natural history of small AAA .. Risk factors for AAA.

3 Diagnosis .. Clinical Imaging techniques .. Ultrasonography .. Computed tomography ..11aWriting Committee: Anders Wanhaineny(chair) (Department of Surgical Sciences, Vascular Surgery , Uppsala University, Uppsala,Sweden), Fabio Verziniy(chair)(Department of Surgical Sciences, Turin University, Turin, Italy), Isabelle Van Herzeele (Department of Thoracic and Vascular Surgery , Univeristy Hosptial Ghent,Ghent, Belgium), Eric Allaire (Department of Vascular Surgery , Mondor University Hospital, Assistance Publique-H pitaux de Paris Universit Paris Est-Cr teil,Cr teil, Cedex, France)

4 , Matt Bown (NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK), Tina Cohnert (Departmentof VascularSurgery, Graz University Hospital, Medical University of Graz, Graz, Austria), Florian Dick (Department of Vascular Surgery , Kantonsspital St. Gallen and University ofBern, Switzerland), Joost van Herwaarden (Department of Vascular Surgery , University Medical CenterUtrecht, Utrecht,The Netherlands), ChristosKarkos(VascularSurgery Unit, 5th Department of Surgery , Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece), Mark Koelemay (Departmentof Surgery ,Academic Medical Center, Amsterdam, The Netherlands), Tilo K lbel (German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center,Hamburg, Germany)

5 , Ian Loftus (St Georges Healthcare NHS Foundation Trust, London, UK), Kevin Mani (Department of Surgical Sciences, Vascular Surgery , UppsalaUniversity, Uppsala, Sweden), Germano Melissano (Department of Vascular Surgery , Universit Vita-Salute San Raffaele Milano, Milan, Italy), Janet Powell (VascularSurgery Research Group, Imperial College, London, UK), Zolt n Szeberin (Department of Vascular Surgery , Semmelweis University, Budapest, Hungary).bESVS Guidelines Committee: Gert J. de Borst (chair) (Utrecht, Netherlands), Nabil Chakfe (Stratsbourg, France), Sebastian Debus (Hamburg, Germany),Rob Hinchliffe (Brinstol, United Kingdom), Stavros Kakkos (Patras, Greece), Igor Koncar (guideline coordinator) (Belgrade, Serbia), Philippe Kolh (Liege,Belgium), Jes Lindholdt (Odense, Denmark), Melina de Vega (Bilbao, Spain), Frank Vermassen (Ghent, Belgium).

6 CDocument reviewers: Martin Bj rck (Uppsala, Sweden), Stephen Cheng (Hong Kong, China), Ronald Dalman (Stanford, USA), Lazar Davidovic (Belgrade,Serbia), Konstantinos Donas (Munster, Germany), Jonothan Earnshaw (Gloucester, United Kingdom), Hans-Henning Eckstein (Munich, Germany), JonathanGolledge (Queensland, Australia), Stephan Haulon (Paris, France), Tara Mastracci (London, United Kingdom), Ross Naylor (Leicester, United Kingdom), Jean-Baptiste Ricco (Poitiers, France), Hence Verhagen (Rotterdam, Netherlands).yThese authors contributed equally.* Corresponding Wanhainen).

7 1078-5884/ 2018 Published by Elsevier on behalf of European Society for Vascular cite this article in press as: Wanhainen A, et al., European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Managementof Abdominal Aorto-iliac Artery Aneurysms, European Journal of Vascular and Endovascular Surgery (2018), J Vasc Endovasc Surg (2018)-, Magnetic resonance imaging .. Positron emission tomography-computed tomography (PET-CT).. Incidental detection .. Screening .. Population screening for AAA in The benefits of ultrasonographic screening for AAA in older Harms, benefits and limitations of ultrasonographic screening for AAA in older persons.

8 Contemporary evidence about population screening .. Surveillance intervals and management of patients with screen detected .. Subaneurysmal aortic dilatation .. Screening in other subgroups .. Smoking .. Ethnicity .. Family history of .. Other peripheral aneurysms and cardiovascular diseases ..153. Management of Patients with Small .. Surveillance and medical management of small AAAs .. Strategies to reduce the rate of aneurysm growth .. Reduction of cardiovascular .. Threshold for elective repair .. Management of patients who have reached the diameter threshold for Surgery but are not considered for early AAA repair.

9 184. Elective AAA Repair .. Pre-operative .. Vascular anatomy assessment .. Operative risk assessment and optimisation .. Assessment and management of cardiac risk .. Assessment and management of pulmonary risk .. Assessment and optimisation of kidney function .. Assessment and optimisation of nutritional Assessment of carotid arteries .. Peri-operative management .. Peri-operative best medical Peri-operative management of antithrombotic therapy for other Antibiotic prophylaxis .. Anaesthesia and post-operative pain management.

10 Post-operative care .. Early recovery after Surgery (ERAS) after open AAA repair .. Intra-operative Radioprotection measures .. Cell salvage .. Techniques for elective AAA repair .. Open repair .. Types of grafts .. Incision and .. Use of heparin .. Surgical repair .. Abdominal closure .. Endovascular repair .. Types of .. Use of heparin .. Accessory renal arteries .. Newer generation of stent grafts .. Laparoscopic aortic repair .. RCT comparing OSR and .. EVAR 1 DREAM OVER trial.