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(ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms

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(ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms Eur J Vasc Endovasc Surg (2019) 57, 8e93 Editor’s Choice e European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms Anders Wanhainen a,y,*, Fabio Verzini a,y, Isabelle Van Herzeele a, Eric Allaire a, Matthew Bown a, Tina Cohnert a, Florian Dick a, Joost van Herwaarden a, Christos Karkos a, Mark Koelemay a, Tilo Kölbel a, Ian Loftus a, Kevin Mani a, Germano Melissano a, Janet Powell a, Zoltán Szeberin a ESVS Guidelines Committee b, Gert J. de Borst, Nabil Chakfe, Sebastian Debus, Rob Hinchliffe, Stavros Kakkos, Igor Koncar, Philippe Kolh, Jes S. Lindholt, Melina de Vega, Frank Vermassen Document reviewers c, Martin Björck, 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 Verhagen TABLE OF CONTENTS List of abbreviations .............................................................................................. 11 1. Introduction and General Aspects ............................................... .........................................12 1.1. Introduction and methods ............................................................................................12 1.1.1. The purpose of these guidelines . ........................................ ....................................12 1.1.2. Methodology . ............................................... ...........................................12 1.1.2.1. Strategy .........................................................................................12 1.1.2.2. Literature search and selection ...................................... ..................................12 1.1.2.3. Weighing the evidence ...............................................................................13 1.1.2.4. The patient’s perspective ........................................ ....................................13 1.2. Service standards .................................................... .............................................13 1.2.1. Quality control . ...........................................................................................13 1.2.2. Resources and availability ............................................ .......................................14 1.2.3. Surgical volume ................................................ ..........................................14 1.2.4. Pathway for treatment .............................................. ........................................15 2. Epidemiology, Diagnosis, and Screening ............................................ .......................................16 2.1. Epidemiology .....................................................................................................16 2.1.1. Definition of abdominal aortic aneurysms ..................................... .................................16 2.1.1.1. Suggested reporting standards for AAA ................................... ...............................16 2.1.2. Prevalence of AAA ............................................... .........................................17 2.1.3. Natural history of small AAA .................................................................................17 2.1.4. Risk factors for AAA .......................................................................................17 2.2. Diagnosis ....................................................... ................................................17 2.2.1. Clinical signs . ............................................... ...........................................17 2.2.2. Imaging techniques ........................................................................................17 2.2.2.1. Ultrasonography ............................................ .......................................17 2.2.2.2. Computed tomography angiography .................................... ................................18 2.2.2.3. Magnetic resonance imaging ..........................................................................19 y y a Writing Committee: Anders Wanhainen (chair) (Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden), Fabio Verzini (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-Hôpitaux de Paris Université Paris Est-Créteil, Créteil, Cedex, France), Matt Bown (NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK), Tina Cohnert (Department of Vascular Surgery, Graz University Hospital, Medical University of Graz, Graz, Austria), Florian Dick (Department of Vascular Surgery, Kantonsspital St. Gallen and University of Bern, Switzerland), Joost van Herwaarden (Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands), Christos Karkos (Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece), Mark Koelemay (Department of Surgery, Ac- ademic Medical Center, Amsterdam, The Netherlands), Tilo Kölbel (German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany), Ian Loftus (St Georges Healthcare NHS Foundation Trust, London, UK), Kevin Mani (Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden), Germano Melissano (Department of Vascular Surgery, Universitá Vita-Salute San Raffaele Milano, Milan, Italy), Janet Powell (Vascular Surgery Research Group, Imperial College, London, UK), Zoltán Szeberin (Department of Vascular Surgery, Semmelweis University, Budapest, Hungary). b ESVS 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 S. Lindholt (Odense, Denmark), Melina de Vega (Bilbao, Spain), Frank Vermassen (Ghent, Belgium). c Document reviewers: Martin Björck (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), Jonathan Golledge (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). y These authors contributed equally. * Corresponding author. E-mail address: [email protected] (Anders Wanhainen). 1078-5884/Ó 2018 Published by Elsevier B.V. on behalf of European Society for Vascular Surgery. https://doi.org/10.1016/j.ejvs.2018.09.020 ESVS 2019 management guidelines for Abdominal Aorto-iliac Artery Aneurysms 9 2.2.2.4. Positron emission tomography-computed tomography (PET-CT) ................................................19 2.2.2.5. Incidental detection .................................................................................19 2.3. Screening ....................................................... ................................................19 2.3.1. Population screening for AAA in men ....................................... ..................................19 2.3.1.1. The benefits of ultrasonographic screening for AAA in older persons ........................ .....................19 2.3.1.2. Harms, benefits and limitations of ultrasonographic screening for AAA in older persons ............... ..............20 2.3.1.3. Contemporary evidence about population screening .............................. ...........................20 2.3.1.4. Surveillance intervals and management of patients with screen detected aneurysm .................. ................21 2.3.2. Subaneurysmal aortic dilatation . ........................................ ....................................21 2.3.3. Screening in other subgroups ........................................... .....................................21 2.3.3.1. Women ..........................................................................................21 2.3.3.2. Smoking ............................................... .........................................21 2.3.3.3. Ethnicity ............................................... .........................................22 2.3.3.4. Family history of AAA .......................................... ....................................22 2.3.3.5. Other peripheral aneurysms and cardiovascular diseases ............................ .........................22 3. Management of Patients with Small AAA ............................................ .......................................22 3.1. Surveillance and medical management of small AAAs ...................................... .................................22 3.1.1. Strategies to reduce the rate of aneurysm growth . ................................ ..............................22 3.1.2. Reduction of cardiovascular risk . ........................................ ....................................23 3.2. Threshold for elective repair ..........................................................................................23 3.2.1. Management
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