What’s new and different with ESVS guidelines for aortoabdominal aortic and iliac aneurysms?


On Thursday afternoon, Karin Elisabeth Schmidt, MD, of the Center of Cardiovascular Surgery, Hospital Floridsdorf, Vienna, Austria, will discuss the guidelines of the European Society of Vascular Surgery (ESVS) for the management of abdominal and iliac aortic aneurysms, which were published in January 2019. “Since the last guideline, this field has experienced a rapid technological devices progress, significantly impacting our clinical practice as well as the care of the affected patients,” according to Dr. Schmidt and her colleagues.

They analyzed the different recommendations of the European, British and American guidelines for the treatment of abdominal aortic aneurysms was performed. The publications used for this literature study include the current and previous guidelines of the ESVS published in the European Journal of Vascular and Endovascular Surgery and the guideline published by the Society for Vascular Surgery (SVS) in January 2018, as well as the draft guideline of the National Institute for Health and Care Excellence (NICE) issued in May 2018.

There is consensus for the preference of endovascular treatment of a ruptured aortic aneurysm if this is anatomically possible, according to Dr. Schmidt. She will discuss how, for the majority of elective cases, endovascular care is favored in the SVS and ESVS guidelines in contrast to the NICE draft.

There are generally still more ambiguities than clear recommendations, especially regarding the preferred procedures for complex aortic pathologies, population screening, and follow-up after open and endovascular aortic intervention.

She recommended a critical analysis of the U.S. and European guidelines, as both partly cover different aspects.

The final version of the guideline for the United Kingdom is eagerly expected, according to Dr. Schmidt and her colleagues, as it currently prefers open surgical care in the elective setting. Many research possibilities exist in the search for biomarkers for better assessment of the progression of small aortic aneurysms coupled with functional imaging or pharmacologic influence on aneurysm growth progression. In addition, global platforms for data collection, in particular for newer devices (low profile) and their long-term performance with jointly defined endpoints, should be established.

Dr. Schmidt will discuss how techniques such as artificial intelligence and machine learning will be used in future for monitoring large amounts of data, finding patterns and thus gain new insights.

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