Evaluating a high-risk patient for a high-risk operation is complicated. Discussing the benefits and burdens with your patient is only a part of the process. Should the decision be not to operate, explaining and planning the nonoperative path forward with all of its inherent challenges is crucial. Because the inevitable is likely to happen, the patient as well as their family must be prepared. If they are not, then the result may be exactly what the patient was hoping to avoid in the first place by declining the operation. Critical to this conversation is understanding the nuances of “doing everything” when dealing with a patient facing a life-limiting condition.
HoornwegLLStorm-VerslootMNUbbinkDT, et al.Meta analysis on mortality of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2008;35(5):558-570.
2.
HirschATHaskalZJHertzerNR, et al.ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation. 2006;113(11):e463-e654.
3.
KarthikesalingamAVidal-DiezAHoltPJ, et al.Thresholds for abdominal aortic aneurysm repair in England and the United States. N Engl J Med. 2016;375:2051-2059.
4.
ChaikofELDalmanRLEskandariMK, et al.The society for vascular surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.
