Table 6.
Recommendations for Management of Abdominal Aortic Aneurysm
| 2005 Recommendations | 2011 Focused Update Recommendations | Comments |
|---|---|---|
| Class I | ||
| Open repair of infrarenal AAA and/or common iliac aneurysms is indicated in patients who are good or average surgical candidates. (Level of Evidence: B) | 1. Open or endovascular repair of infrarenal AAAs and/or common iliac aneurysms is indicated in patients who are good surgical candidates (56,57). (Level of Evidence: A) | Modified recommendation (endovascular repair incorporated from 2005 Class IIb recommendation [see below*]; level of evidence changed from B to A). |
| Periodic long-term surveillance imaging should be performed to monitor for an endoleak, to document shrinkage or stability of the excluded aneurysm sac, and to determine the need for further intervention in patients who have undergone endovascular repair of infrarenal aortic and/or iliac aneurysms. (Level of Evidence: B) | 2. Periodic long-term surveillance imaging should be performed to monitor for endoleak, confirm graft position, document shrinkage or stability of the excluded aneurysm sac, and determine the need for further intervention in patients who have undergone endovascular repair of infrarenal aortic and/or iliac aneurysms (56,58). (Level of Evidence: A) | Modified recommendation (level of evidence changed from B to A). |
| Class IIa | ||
| Endovascular repair of infrarenal aortic and/or common iliac aneurysms is reasonable in patients at high risk of complications from open operations because of cardiopulmonary or other associated diseases. (Level of Evidence: B) | Deleted recommendation (no longer current). | |
| 1. Open aneurysm repair is reasonable to perform in patients who are good surgical candidates but who cannot comply with the periodic long-term surveillance required after endovascular repair. (Level of Evidence: C) | New recommendation | |
| Class IIb | ||
| Endovascular repair of infrarenal aortic and/or common iliac aneurysms may be considered in patients at low or average surgical risk. (Level of Evidence: B) | Deleted recommendation (endovascular repair incorporated into 2011 Class I, #1 [see above*]). | |
| 1. Endovascular repair of infrarenal aortic aneurysms in patients who are at high surgical or anesthetic risk as determined by the presence of coexisting severe cardiac, pulmonary, and/or renal disease is of uncertain effectiveness (59). (Level of Evidence: B) | New recommendation |
*
Indicates merging of deleted 2005 Class IIb recommendation with the modified 2011 Class I, #1 recommendation.
AAA indicates abdominal aortic aneurysm.