SVS Seeks Comments on New Clinical Practice Guidelines on AAA Patient Care
July 20, 2017—The Society for Vascular Surgery (SVS) announced that the SVS Document Oversight Committee is requesting members' comments on the proposed SVS Clinical Practice Guideline regarding the treatment of patients with abdominal aortic aneurysms (AAAs).
The proposed guideline by Elliot L. Chaikof, MD, et al is titled “The Care of Patients with an Abdominal Aortic Aneurysm” and is accessible for review and comments here on the SVS website. Comments must be submitted by August 1.
As stated in the proposed guideline, "This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical comorbidities, guidelines for intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications."
Because decision making related to the care of patients with AAAs is complex, the guideline stresses, "Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical comorbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity."
It continues, "All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary."
The document provides a summary of the guideline for care and indicates the level of the recommendation (strong, weak, or good practice statement) and the quality of the evidence supporting it (high, moderate, or low). A comprehensive review of the available clinical evidence in the literature was conducted to generate a concise set of recommendations, noted the guideline.
Recommendations are provided in the following areas: physical examination, assessment of medical comorbidities, aneurysm imaging, the decision to treat, timing for intervention, assessment of operative risk and life expectancy, endovascular aneurysm repair (EVAR), perioperative outcomes of elective EVAR, the role of elective EVAR in the high-risk and unfit patient, open surgical repair, perioperative outcomes of open AAA repair, the patient with a ruptured aneurysm, choice of anesthetic technique and agent, antibiotic prophylaxis, intraoperative fluid resuscitation and blood conservation, cardiovascular monitoring, maintenance of body temperature, role of the intensive care unit, nasogastric decompression and perioperative, prophylaxis for deep vein thrombosis, postoperative blood transfusion, perioperative pain management, late outcomes, and recommendations for postoperative surveillance.