FJVIS 14. Update of the European Society for Vascular Surgery Guidelines for Aortoabdominal and Iliac Aneurysms: What Is New and How Does It Differ From the Society for Vascular Surgery and National Institute for Health and Care Excellence Guidelines in Preparation?

The guidelines of the European Society for Vascular Surgery (ESVS) on the management of abdominal and iliac aneurysms published in January 2019 and updated after the first publication of 2011 are essential reading for all vascular surgeons. Since the last guideline, this field has experienced rapid progress in technologic devices, significantly impacting our clinical practice as well as the care of the affected patients. An analysis of 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 in January 2018. In addition, the draft guideline of the National Institute for Health and Care Excellence issued in May 2018 was included in the analysis. There is consensus for the preference of endovascular treatment of a ruptured aortic aneurysm if this is anatomically possible. For the majority of elective cases, endovascular care is as well favored from the Society for Vascular Surgery and ESVS guidelines in contrast to the National Institute for Health and Care Excellence draft. There are generally still more ambiguities than clear recommendations, especially regarding the preferred procedures for complex aortic diseases, population screening, and follow-up after open and endovascular aortic intervention. A critical analysis of the American and European guidelines is recommended as both partly cover different aspects. The final version of the guideline for the United Kingdom is eagerly expected 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. Global platforms for data collection, in particular for newer devices (low profile) and their long-term performance with jointly defined end points, should be established. In the near future, techniques such as artificial intelligence and machine learning will be used for monitoring large amounts of data, finding patterns and thus gaining new insights. The skill of an elective endovascular procedure can be trained early on simulators and later performed on the patient under supervision as a basis for emergency implantation by vascular surgeons in training. However, expertise in the field of open aortic surgery will still continue to be necessary.