Physical Assessment Abdominal Aorta
Indicate the patient’s body habitus
integer
Indicate the presence or absence of palpable abdominal aortic pulsations
boolean
Indicate the characteristics of aortic pulsation
integer
Estimate the diameter of AAA by palpation
float
Indicate the presence of abdominal bruit
boolean
Indicate the presence of tenderness in the abdominal aortic area
boolean
Indicate the presence of abdominal tenderness in areas other than the abdominal aortic area
boolean
Indicate location of abdominal tenderness
text
Indicate the presence of lumbar spinal tenderness
boolean
Indicate the characteristics of pulses in the following locations: - Femoral - Popliteal - Dorsalis pedis - Posterior tibial Indicate if pulses are: 0: Absent 1: Diminished 2: Normal 3: Bounding or expansile
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Diagnostic procedures: noninvasive
Ultrasonography Date of procedure Type of aneurysm: Fusiform / Saccular / Pseudoaneurysm Aneurysm size [mm] in anteroposterior, transverse, and longitudinal dimensions. Indicate the distance from the most proximal portion of the aneurysm to its most distal portion in millimeters. Thrombus: yes/no Dissection: yes/no Leak: yes/no
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Magnetic Resonance Imaging Date of procedure Method of MRA: - Contrast-enhanced MRA: White blood angiogram obtained by lowering the T1 relaxation time of blood below the surrounding tissue - Time-of-flight MRA: White blood angiogram generated by using the in-flow effect Contrast (gadolinium) used: yes/no Location of the aneurysm - Thoracoabdominal: Type 1 / 2 / 3 / 4 - Abdominal: proximal extent -- Suprarenal -- Juxtarenal -- Infrarenal - Abdominal: distal extent of the aneurysm is the aorta or whether it involves the iliac arteries. -- Aorta -- Aortoiliac: Bi-iliac / Left iliac / Right iliac Type of aneurysm: Fusiform / Saccular / Pseudoaneurysm Aneurysm: size [mm] by recording the maximum axial dimension measured from outer margin to outer margin. The axial dimension should be perpendicular to blood flow. Indicate the distance from the most proximal portion of the aneurysm to the most distal portion in millimeters. Thrombus: yes/no Dissection: yes/no Leak: yes/no Indicate other arteries imaged and indicate the patency or severity of stenosis - Celiac artery - Superior mesenteric artery - Inferior mesenteric femoral artery - Right renal artery - Left renal artery - Right/left CIA - Right/left external iliac artery - Right/left common femoral artery - Right/left internal iliac artery
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CT method: Standard /Spiral (helical) / Electron beam Date of procedure Contrast used: - Ionic - Nonionic; specify: -- Monomer -- Dimer Contrast volume [ml] Slice thickness [mm] Format: raw images were reviewed: yes/no Format: reconstructed images were reviewed: yes, Shaded surface images / yes, Maximum intensity projection / no Aneurysm location: - Thoracoabdominal: Type 1 / 2 / 3 / 4 - Abdominal,proximal extent of the aneurysm: Suprarenal / Juxtarenal / Infrarenal — Abdominal, distal extent of the aneurysm is the aorta or whether it involves the iliac arteries: -- Aorta -- Aortoiliac -- Bi-iliac -- Left iliac -- Right iliac Type of aneurysm: - Fusiform - Saccular - Pseudoaneurysm Aneurysm size [mm] by recording the maximum axial dimension from outer margin to outer margin. The axial dimension should be perpendicular to blood flow. Distance from the most proximal portion of the aneurysm to the most distal portion in millimeters. Aortic neck morphology: - Presence or absence of calcification - Presence or absence of thrombus within the neck - Degree of angulation in the neck - Diameter of the neck - Length of the neck from the lowest renal artery to the origin of the aneurysm Thrombus: yes/no Dissection: yes/no Leak: yes/no Indicate other arteries imaged and the patency or severity of stenosis. Choose all that apply: - Celiac artery - Superior mesenteric artery - Inferior mesenteric femoral artery - Right renal artery - Left renal artery - Right/left CIA - Right/left external iliac artery - Right/left common femoral artery
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Diagnostic Procedures: Invasive
Catheter Angiography Date of procedure Contrast type Contrast amount [ml] Indicate the total fluoroscopy time recorded to the nearest 0.10 min. Time recorded should include the total time for the procedure. Aneurysm location: - Thoracoabdominal: Type 1 / 2 / 3 / 4 - Abdominal, proximal extent: Suprarenal / Juxtarenal / Infrarenal — Abdominal, distal extent: Aorta / Aorto-iliac / Bi-iliac / Left iliac / Right iliac Type of aneurysm: Fusiform / Saccular / Pseudoaneurysm Size of aneurysm [mm] by recording the maximum axial dimension measured from outer margin to outer margin. The axial dimension should be perpendicular to blood flow. Distance from the most proximal portion of the aneurysm to the most distal portion in millimeters. Thrombus: yes/no Dissection: yes/no Leak: yes/no Indicate other arteries imaged and the patency or severity of stenosis. Choose all that apply: - Celiac artery - Superior mesenteric artery - Inferior mesenteric femoral artery - Right renal artery - Left renal artery - Right/left CIA - Right/left external iliac artery - Right/left common femoral artery
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Treatment: Invasive Therapeutic Procedures
Open AAA Repair Date of procedure Operator name Extent of aneurysm: - Thoracoabdominal: Type 1 / 2 / 3 / 4 - Associated dissection: yes/no Infrarenal: - Aorta - Aortoiliac -- Bi-iliac -- Left iliac -- Right iliac Proximal clamping site: - Thoracoabdominal: -- Above the mesenteric arteries -- Descending thoracic aorta -- Hypothermic circulatory arrest (no clamp) -- Distal to left subclavian artery -- Proximal to left subclavian artery - Infrarenal: -- Infrarenal -- Supraceliac -- Suprarenal Clamp time proximal Clamp time to restoration of visceral flow Total clamp time Distal clamping site: - Thoracic Clamp site - Segmental clamping: yes/no - Infrarenal: -- Aorta -- CIA -- EIA and IIA Neuroprotection technique (thoracoabdominal) - Clamp and sew (no protection) - Preoperative imaging of spinal perfusion - Retrograde perfusion -- Atrial-femoral bypass -- Axillo-femoral bypass -- Femoro-femoral bypass -- Shunt -- Others: specify - Neurologic monitoring - CSF drainage - Systemic cooling - Epidural cooling - Reimplantation of intercostal arteries: Specify how many Type of graft: - Polyester woven - Polyester knitted - PTFE - Infrarenal: -- Tube graft -- Bifurcated graft -- Site of distal anastomoses (iliac or femoral arteries) Management of visceral segment for thoracoabdominal - Visceral patch, including celiac artery, SMA, right renal artery, and left renal artery. - Visceral patch, including celiac artery, SMA, and right renal artery with left renal artery either bypassed or implanted into aortic graft separately - Individual bypasses to visceral and renal arteries. - Indicate if visceral organ protection was used. If so, specify type (perfusion, cold infusion) Management of inferior mesenteric artery - Chronically occluded - Oversewn - Reimplanted Intraoperative Details for Open AAA Repair Additional procedures: - Renal artery bypass/endarterectomy - Visceral artery procedure (specify) - Other (specify) Intraoperative complications: Yes (specify) / No
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Endovascular AAA Repair Date of procedure Operator name Aortic and iliac diameters and lengths - Aortic diameter at lowest renal artery - Aortic diameter 1.5 cm below lowest renal artery - Aortic diameter at terminal aorta - Maximum diameter of right CIA - Maximum diameter of left CIA - Minimum diameter of right EIA - Minimum diameter of left EIA - Length of aorta from lowest renal artery to aortic bifurcation - Length from aortic bifurcation to right IIA - Length from aortic bifurcation to left IIA Type of graft used: - Fixation -- Infrarenal -- Suprarenal - Unibody - Bifurcated -- 1 docking limb -- 2 docking limbs Number of hypogastric arteries excluded: 0 / 1 / 2 Management of inferior mesenteric artery: - Chronically occluded/covered - Coil occluded Extension used: - Distal -- Number and size placed -- Landing zone: CIA / EIA - Proximal — Number and size placed Adjunctive procedures: - Adjunctive angioplasty or stent required. Specify the following: -- Side: indicate left or right -- Location: CIA, IIA, EIA -- Indication - Conduit used for insertion of endograft. Specify the following: -- Side: indicate left or right -- Size and type of graft material of conduit -- Indication - Accessory renal artery management. Specify the following: -- Side: indicate left or right -- Site of artery -- Size of artery -- Treatment: Embolization / Coverage - Iliac embolization. Specify the following: -- Side: indicate left or right -- Size: balloon or stent -- Indication Endograft configuration: - Aorto–bi-iliac - Aorto–uni-iliac graft with femoral artery to femoral artery bypass and iliac artery occlusion Aortic neck morphology: - Presence or absence of calcification - Presence or absence of thrombus within neck - Degree of angulation in the neck. Specify C-arm correction angle in degrees. - Diameter of the neck - Length of the neck from the lowest renal artery to the origin of the aneurysm Intraoperative Details for Endovascular AAA Repair Endoleak present at the end of the case: - Type I - Type II - Type III - Type IV - Undetermined Limb kinking If present, specify the following: - Site - Size - How it was resolved Patency of arteries: - Right/left renal arteries: -- Number - Right/left accessory renal arteries -- Number - Right/left common/external iliac arteries Intraoperative complications: - No - Arterial injury -- Indicate right or left side -- Indicate artery injured - Embolization: --Indicate site — Inadvertent covering of artery -- Indicate site
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Estimated blood loss
integer
Indicate the blood products transfused to the patient
integer
Indicate the total time of procedure in hours:minutes.
durationDatetime
Indicate when the patient was extubated post procedure. Choose 1 of the following:
integer
Indicate the day of oral intake.
integer
Indicate the length of stay in the ICU. Specify the number of days or indicate not applicable.
integer
Indicate the length of stay in a step-down unit. Specify the number of days or indicate not applicable.
integer
Indicate postoperative complications
integer
Indicate total length of stay in the hospital in number of days.
integer
Indicate the patient’s discharge status. Discharged to home or self-care includes discharge to home; jail or law enforcement; home on oxygen if DME only; any other DME only; group home, foster care, and other residential care arrangements; outpatient programs such as partial hospitalization or outpatient chemical dependency programs; assisted living facilities that are not state designated.
integer
Patient Education/Counseling
Verbal and written medication instructions provided to patient and/or family
text
Verbal and written instructions provided to patient and/or family (by physician or nurse) about new or worsening symptoms and when to call the physician
text
Advice given or discussion held with patient and/or family about the importance of diet in relation to lowering cardiovascular risk
integer
Advice given or discussion held with patient (by physician, nurse, or other personnel) about the importance of stopping smoking
integer
Advice given or discussion held with patient and/or family about activity level and restrictions in activity and/or exercise recommendations
text
Follow-Up
Documentation of follow-up evaluation of patient 2 to 4 wk after discharge should include - Physical examination - Duplex ultrasound to check integrity of repair CT scan of chest, abdomen, and pelvis should be considered within 5 y to evaluate for synchronous aneurysms.
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Documentation of follow-up evaluation of patient 4 wk after discharge should include ● Physical examination ● CT scan of abdomen and pelvis ● Plain film of abdomen to access stent integrity and migration
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Outcomes of Open AAA and Endovascular Repair
Indicate the period at which outcome measures are assessed
integer
Indicate major clinical complications arising from management or treatment of the disease
boolean
Indicate postoperative clinical events or conditions associated with endovascular procedure Major complication - Death - MI (also see cardiovascular complications below): -- Prolonged hospitalization -- Loss of limb or function of organ system -- Persistent or significant disability or incapacity -- Dissection -- Pseudoaneurysm -- Vessel thrombosis -- Vessel rupture - Stroke -- Cerebral -- Spinal cord stroke — Other life-threatening major complication (specify) -- Seroma -- Hematoma -- Mesenteric ischemia -- Renal failure -- Pneumonia -- Atheromatous embolization -- DVT -- Contrast nephropathy -- Contrast hypersensitivity -- Infection -- Requirement for intervention to prevent permanent impairment/damage -- Postimplant syndrome - Minor complication (specify)
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Indicate complications of open surgery. Choose all that apply: ● Major complication — Death — MI (also see cardiovascular complications below): X Prolonged hospitalization X Loss of limb or function of organ system X Persistent or significant disability or incapacity X Dissection X Pseudoaneurysm X Vessel thrombosis X Vessel rupture — Stroke X Cerebral X Spinal cord stroke — Other life-threatening major complication (specify) X Seroma X Hematoma X Mesenteric ischemia X Renal failure X Pneumonia X Atheromatous embolization X DVT X Contrast nephropathy X Contrast hypersensitivity X Infection X Requirement for intervention to prevent permanent impairment/damage X Postimplant syndrome ● Minor complication (specify)
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Graft or endograft-related outcomes ● Patency — Primary — Assisted — Secondary ● Ischemic rest pain ● Ischemic tissue loss ● Amputation
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New cardiovascular ischemic event ● Angina ● MI ● Coronary artery revascularization ● CHF ● TIA ● Ischemic stroke ● Hemorrhagic stroke ● Stroke (unknown if ischemic or hemorrhagic) ● Death
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Pulse examination
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ABI
float
Open AAA repair: long-term outcomes
integer
Endovascular AAA repair: long-term outcomes
integer