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Review
. 2023 Mar 7;19(2):78-89.
doi: 10.14797/mdcvj.1177. eCollection 2023.

Houston Methodist Ruptured Abdominal Aortic Aneurysm Guidelines

Vy C Dang  1 , Peter J Osztrogonacz  2 , Paul Haddad  2 , Shashank Sharma  2 , Stuart J Corr  2   3   4   5 , Maham Rahimi  2
Affiliations
Review

Houston Methodist Ruptured Abdominal Aortic Aneurysm Guidelines

Vy C Dang et al. Methodist Debakey Cardiovasc J. .

Abstract

Ruptured abdominal aortic aneurysm (RAAA) is an acute aortic condition that requires emergent intervention and appropriate continuity of care to optimize patient outcomes. We describe the standardized RAAA protocol at the Houston Methodist Hospital Acute Aortic Treatment Center, developed to navigate critical patient transfer periods safely and efficiently, make crucial decisions about surgical intervention, and clearly communicate these plans with other care team providers. Our workflow is organized into five phases: prehospital, preoperative, intraoperative, postoperative, and post-discharge. We identify the transfer center, anesthesia, operating room nursing staff, surgeons, and intensive care unit as key entities of our acute aortic pathology care team. This systematic protocol for the management of acute aortic emergencies such as RAAA identifies critical decision points, potential complications at each stage, and recommendations for best practice.

Keywords: RAAA Timeout; THROMBINS2; acute aortic syndromes; guidelines; patient outcomes; protocol; ruptured abdominal aortic aneurysm; transfer of care.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Algorithm for preoperative blood pressure and volume management. Hemodynamic stability is defined as patient consciousness with no fluid/pressors to maintain blood pressure between 70-90 mm Hg for at least 5 minutes. BP: blood pressure; EVAR: endovascular aortic repair; EVBC: endovascular balloon control; OSR: open surgical repair; SBP: systolic blood pressure
Figure 1
Algorithm for preoperative blood pressure and volume management. Hemodynamic stability is defined as patient consciousness with no fluid/pressors to maintain blood pressure between 70-90 mm Hg for at least 5 minutes. BP: blood pressure; EVAR: endovascular aortic repair; EVBC: endovascular balloon control; OSR: open surgical repair; SBP: systolic blood pressure.
Algorithm of postoperative ruptured AAA surveillance recommendations
Figure 2
Algorithm for postoperative ruptured aortic abdominal aneurysm surveillance based on Society of Vascular Surgery guidelines and Houston Methodist Hospital protocol. CT: computed tomography; EVAR: endovascular aortic repair; OR: operating room.
See this image and copyright information in PMC

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