This protocol addresses the management of unruptured abdominal aortic aneurysm at the stage when initial medical therapy and cardiovascular risk-factor modification have not achieved target blood pressure goals, and aneurysm repair becomes the indicated course of action.
The preceding management line consisted of medical therapy and risk-factor modification — directed at achieving a systolic blood pressure below 130 mm Hg and a diastolic blood pressure below 80 mm Hg, among other risk-reduction goals. This protocol applies when those blood pressure targets were not met.
Repair of the abdominal aortic aneurysm — via an endovascular or an open surgical approach — is the intervention at this stage. Which approach is appropriate depends on anatomical suitability and the patient's perioperative risk profile. The full decision criteria and procedural specifics are detailed in the complete protocol.
DOI: 10.1016/j.ejvs.2023.11.002
In patients with nonruptured AAA with low to moderate operative risk and who have anatomy suitable for either open or EVAR, a shared decision-making process weighing the risks and benefits of each approach is recommended.
In patients undergoing elective endovascular repair for nonruptured AAA, adherence to manufacturer's instructions for use is recommended.
In patients with nonruptured AAA and a high perioperative risk, EVAR is reasonable to reduce the risk of 30-day morbidity, mortality, or both.
For patients with nonruptured AAA, a moderate to high perioperative risk, and anatomy suitable for an FDA-approved fenestrated endovascular device, endovascular repair is reasonable over open repair to reduce the risk of perioperative complications.
In patients undergoing endovascular repair of AAA who have suitable common femoral artery anatomy, ultrasound-guided percutaneous access and closure is recommended over open cutdown to reduce operative time, blood loss, length of stay, time to wound healing, and pain.
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