Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ ABDOMINAL AORTIC ANEURYSM (AAA) +++ Population ++ – Adults. +++ Recommendations +++ ACCF/AHA 2005/2011 ++ Pharmacologic Therapy ++ – Monitor and control BP and fasting serum lipids as recommended for patients with atherosclerotic disease (Class I, LOE C). – Smoking cessation: Provide counseling and medications to all patients with AAA or family history of AAA. – Monitor patients with infrarenal or juxtarenal AAA 4.0–5.4 cm in diameter with ultrasound or CT scan every 6–12 mo to detect expansion (Class I, LOE A). – Monitor patients with AAA <4.0 cm in diameter with ultrasound every 2–3 y (Class IIa, LOE B). – In patients undergoing surgical repair of AAA, administer beta-adrenergic blocking agents perioperatively, in the absence of contraindications, to reduce the risk of adverse cardiac events and mortality (Class I, LOE A). ++ Surgical Therapy ++ – Repair infrarenal or juxtarenal AAA ≥5.5 cm in diameter to eliminate risk of rupture (Class I, LOE B). – Consider repair of suprarenal or type IV thoracoabdominal aortic aneurysm >5.5–6.0 cm diameter (Class IIa, LOE B). – Do not repair asymptomatic infrarenal or juxtarenal AAA if <5.0 cm in diameter in men or <4.5 cm in diameter in women (Class III, LOE A). – Obtain immediate surgical evaluation for patients with clinical triad of abdominal and/or back pain, a pulsatile abdominal mass, and hypotension (Class I, LOE B). – Repair symptomatic AAA regardless of diameter (Class I, LOE C). – In patients who are good surgical candidates, recommend open repair or EVARa of infrarenal and/or common iliac aneurysms. – After EVAR of infrarenal aortic and/or iliac aneurysms, perform periodic long-term surveillance imaging to monitor for vascular leak, document shrinkage/stability of the excluded aneurysm sac, confirm graft position, and determine the need for further intervention (Class I, LOE A). – Consider open aneurysm repair for patients who are good surgical candidates but who cannot comply with the periodic long-term surveillance required after endovascular repair (Class IIa, LOE C). – Endovascular repair of infrarenal aortic aneurysm in patients who are at high surgical or anesthetic risk (presence of coexisting severe cardiac, pulmonary, and/or renal disease) is of uncertain effectiveness (Class IIb, LOE B). +++ ESC 2014 ++ Pharmacologic Therapy ++ – Recommend smoking cessation slow the growth of the AAA. – In patients with HTN and AAA, give beta-blockers as first-line treatment. – Consider ACEI and statins in patients with AAA to reduce cardiovascular risk. – Consider aspirin therapy. Enlargement of AAA is usually associated with the development of an intraluminal mural thrombus. Overall data on the benefits of ASA in reducing AAA growth are contradictory; however, given the strong association between AAA and other atherosclerotic diseases, the use of ASA may be advisable. – Surveillance without intervention is indicated and safe in patients with AAA with a maximum ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth