Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms
Anders Wanhainen, Isabelle Van Herzeele, Frederico Bastos Gonçalves, Sergi Bellmunt-Montoya, Xavier Bérard, Jonathan R. Boyle, Mario D’Oria, Carlota Fernández Prendes, Christos D. Karkos, Arkadiusz Kazimierczak, Mark J.W. Koelemay, Tilo Kölbel, Kevin Mani, Germano Melissano, Janet T. Powell, Santi Trimarchi, Nikolaos Tsilimparis, George Α. Antoniou, Martin Björck, Raphaël Coscas, Nuno Dias, Philippe Kolh, Sandro Lepidi, Barend Mees, Timothy Resch, Jean‐Baptiste Ricco, Riikka Tulamo, Christopher P. Twine, Daniela Branzan, Stephen W.K. Cheng, Ronald L. Dalman, Florian Dick, Jonathan Golledge, Stéphan Haulon, Joost A. van Herwaarden, Nikola S. Ilic, Arkadiusz Jawień, Tara M. Mastracci, Gustavo S. Oderich, Fabio Verzini, Kak Khee Yeung
Abstract
OBJECTIVE: The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS: The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS: A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION: The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.