Department of Vascular Surgery, Careggi University Hospital, Florence, Italy.
Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
J Cardiovasc Surg (Torino). 2022 Jun;63(3):328-352. doi: 10.23736/S0021-9509.22.12330-X.
The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics.
这些指南的目的是根据国家指南系统 (SNLG) 修订和更新之前的 2016 年意大利腹部主动脉瘤疾病指南，以指导每位从业者为该病理学选择最正确的管理途径。本更新应用的方法学步骤是 GRADE-SIGN 版本方法，同时也遵循了 AGREE 报告质量清单的说明。第一个方法学步骤是根据 PICO（人群、干预、比较、结果）模型制定结构化的临床问题，根据该模型发布了建议。然后，对每个 PICO 问题或同质问题组进行了文献系统评价，随后选择了文章，并使用定性检查表对每篇文章进行了方法学质量评估。最后，为每个临床问题填写了考虑判断表，其中评估了整个证据的特征，以确定从证据水平到建议的方向和强度的转变。这些指南概述了在筛查和监测方面正确管理腹主动脉瘤患者的方法。讨论了医疗管理和手术适应证，以及患者背景和手术风险评估的术前评估。一旦确立了手术适应证，就描述并比较了传统开放手术和血管内手术的选择，特别关注破裂性腹主动脉瘤患者。最后，解释了术后早期和晚期随访的适应证。文献中的最新证据能够证实并可能修改以前的建议，对前瞻性相关主题提出新的建议。
