General Principles

in Aortic Aneurysmal Disease

Applied

Type

Addition

Confidence

90%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The ESVS 2025 guidelines on vascular trauma provide the most current evidence-based recommendations for the management of acute vascular hemorrhage, which are directly applicable to the 'General Principles' of managing ruptured aneurysms. This integration adds specific clinical targets (SBP 70-90 mmHg) and modern endovascular adjuncts (REBOA) while providing necessary geographic balance by pairing the existing US (SVS) guidelines with the new European (ESVS) standards.

Evidence

Wahlgren CM, et al. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma. Eur J Vasc Endovasc Surg. 2025. PMID: 39809666.

These 2025 ESVS clinical practice guidelines provide comprehensive and up to date advice to physicians and patients on the management of diseases of the mesenteric and renal arteries and veins.

Verified source
PubMedDOISource

Content Changes

* rAAA,Ruptured rTAA,abdominal aortic aneurysm (rAAA), ruptured thoracic aortic aneurysm (rTAA), and ruptured iliac aneurysms are life-threatening emergencies with overall mortality often >50% including prehospital deaths [@powell2014-improve].
* Regionalized pathways with 24/7 computed tomography angiography (CTA), endovascular capability, blood products, and hybrid ORsoperating rooms (ORs) are recommended [@svs2018].[@svs2018, @esvs2025].
* Initial management:management includes permissive hypotension,hypotension (target systolic blood pressure 70–90 mmHg), massive transfusion protocol,protocol (MTP), and rapid CT-based triage in stable or semi-stable patients;patients an[@improve2017, @esvs2025]. In patients with profound shock, resuscitative endovascular balloon occlusion of the aorta (REBOA) may be utilized as a bridge to definitive repair [@esvs2025]. An endovascular aneurysm repair (EVAR)-first strategy is feasible in many rAAA and supported by randomized strategy data [@improve2017].
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