ESVS Publishes 2019 Clinical Practice Guidelines on Management of Abdominal Aortoiliac Artery Aneurysms

 

February 7, 2019—The European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aortoiliac artery aneurysms have been published by Anders Wanhainen, MD, et al in European Journal of Vascular and Endovascular Surgery (EJVES).

According to the document, the ESVS developed these guidelines for the care of patients with aneurysms of the abdominal aorta and iliac artery, with the aim of assisting physicians in selecting the best management strategy. Members of the Guideline Writing Committee (GWC) were selected by the ESVS to represent physicians involved in the management of these patients. The guidelines were written and approved by the 16 members of the GWC, who are all members of the ESVS. The ESVS Guidelines Committee (GC) was responsible for the endorsement process of the guidelines.

As noted in the document's introduction in EJVES, the first ESVS abdominal aortic aneurysm (AAA) guidelines were published in 2011 as a supplement in EJVES under the leadership of Frans Moll, MD, and they have had a major impact on clinical practice and research. In 2015, the ESVS GC, under the leadership of Philippe Kolh, MD, initiated a process to update the AAA guidelines.

The document advises that the 2019 guidelines are a complete makeover and include several topics that were not addressed in the 2011 guidelines, including:

  • Juxtarenal AAA, isolated iliac aneurysms, mycotic and inflammatory aneurysms, and concomitant malignant disease
  • New treatment concepts, such as fenestrated endovascular aneurysm repair (EVAR), chimney EVAR, and endovascular aneurysm sealing
  • Service standards and logistics of importance, including surgical volume requirements and acceptable waiting time for surgery
  • The patient's perspective, included for the first time in an ESVS guideline

Additionally, several updated recommendations have been made based on new data/evidence for already established topics, including:

  • Recommendations on an EVAR-first strategy for ruptured AAA
  • A stratified, less frequent follow-up regimen after EVAR
  • An updated surveillance protocol for small AAAs and subaneurysms

The document states that the guidelines are based on scientific evidence completed with expert opinion on the matter. By summarizing and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated.

The recommendations represent the general knowledge at the time of publication, but technology and disease knowledge in this field may change rapidly, making recommendations outdated. It is an aim of the ESVS to update the guidelines when important new insights in the evaluation and management of diseases of the abdominal aorta and iliac artery become available, advised the GWC in the introduction to the guidelines in EJVES.

 

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