Clinical Reference Tables

in Aortic Aneurysmal Disease

Applied

Type

Modification

Confidence

90%

Created

Apr 27, 2026

Evidence

1 source

Rationale

The ESVS 2024 guidelines (PMID 38307694) supersede the ESVS 2019 guidelines (wanhainen 2019) for AAA management recommendations. Per the stale guideline replacement instructions, all three instances where wanhainen 2019 was cited for surveillance protocol recommendations in Table 4.4 have been replaced with ESVS. The guideline source labels in the table have been updated from 'ESVS 2019' to 'ESVS 2024' accordingly. No other content changes were required as the surveillance protocol structure itself remains consistent with current guidance. The SVS 2018 citations are retained where they appear alongside the ESVS citation, as they represent a distinct guideline body.

Evidence

ESVS. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2024. PMID: 38307694. DOI: 10.1016/j.ejvs.2023.11.002.
Verified source
PubMedDOI

Content Changes

<!-- type: risk-factors -->
**Table 4.1. Major Risk Factors for Aneurysm Formation**

| **Category** | **Risk Factors** |
| --- | --- |
| **Non-modifiable** | Age, Male sex, Family history, Genetic disorders (Marfan, Loeys-Dietz, Ehlers-Danlos) |
| **Modifiable** | Smoking, Hypertension, Hyperlipidemia, Atherosclerosis, Inflammation |
| **Other factors** | Chronic obstructive pulmonary disease (COPD), Aortic wall infection, Trauma/Iatrogenic injury |

<!-- type: comparison -->
**Table 4.2. Comparison of abdominal aortic aneurysm (AAA) Repair Options**

| **Approach** | **Advantages** | **Disadvantages** | **Key Evidence (RCT/Registry)** |
| --- | --- | --- | --- |
| **Open repair** | Durable, long-term survival | Higher perioperative risk, longer recovery | DREAM, OVER, MASS [@dream2005] [@over2012] [@mass2002] |
| **Standard endovascular aneurysm repair (EVAR)** | Minimally invasive, lower early mortality | Requires suitable anatomy, reinterventions | EVAR-1, ACE, Swedvasc [@evar2010-evar-1] [@becquemin2011] [@swedvasc2022] |
| **FEVAR/BEVAR** | Allows treatment of complex anatomy | Custom-made, technical complexity | GLOBALSTAR, Vascunet [@vascunet2021] |
| **PMEG** | On-table modification for urgent cases | Off-label, operator-dependent | PMEG Registry [@katsargyris2017] |
| **Chimney/ChEVAR** | Off-the-shelf, useful in emergencies | Higher risk of endoleak (Type Ia, gutter) | PERICLES Registry [@oikonomou2019] |

<!-- type: classification -->
**Table 4.3. Endoleak Classification**

| **Type** | **Description** | **Clinical significance** |
| --- | --- | --- |
| **I** | Proximal or distal seal failure | High rupture risk → reintervention |
| **II** | Retrograde filling via branch (IMA, lumbar) | Most common, usually benign |
| **III** | Graft defect or modular disconnection | High rupture risk → urgent repair |
| **IV** | Graft porosity | Rare with modern grafts |
| **V** | Endotension (no visible leak, sac expansion) | Unclear, may require surveillance |

<!-- type: surveillance -->
**Table 4.4. Surveillance Protocols After Aneurysm Repair**

| **Procedure** | **1 mo** | **6 mo** | **12 mo** | **Annual** | **Guideline Source** |
| --- | --- | --- | --- | --- | --- |
| **EVAR** | computed tomography angiography (CTA)/DUS | – | CTA/DUS | CTA/DUS | ESVS 2019,2024, SVS 2018 [@wanhainen2019][@esvs2024-editors] [@svs2018] |
| **FEVAR/BEVAR** | CTA | CTA | CTA | Annual CTA | Vascunet, ESVS 20192024 [@vascunet2021] [@wanhainen2019][@esvs2024-editors] |
| **thoracic endovascular aortic repair (TEVAR)** | CTA | CTA | CTA | Annual CTA | SVS 2018 [@svs2018] |
| **Open AAA** | – | – | – | Symptom-driven | SVS 2018 [@svs2018] |
| **Popliteal aneurysm repair** | DUS | – | DUS | Annual DUS | ESVS 20192024 [@wanhainen2019][@esvs2024-editors] |
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