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cardio.hypertensive-emergency.acute-aortic-aneurysm-with-malperfusion.v1PRODUCTION
cardio.hypertensive-emergency.acute-aortic-aneurysm-with-malperfusion.v1

Acute aortic aneurysm + malperfusion in hypertensive emergency (anti-impulse + emergent endovascular/open repair)

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Detailed

Acute aortic aneurysm + malperfusion in HTN crisis: aneurysm-driven (NOT dissection-driven) phenotype with rapid expansion / contained leak / branch compromise. Anti-impulse paradigm: HR <60 + dP/dt FIRST, THEN SBP 100-120 (permissive hypotension until proximal control). Endovascular FIRST for descending thoracic (TEVAR) + abdominal infrarenal (EVAR) per IRAD/SVS/ESVS 2024; OPEN REPAIR for ascending or complex anatomy. Branch malperfusion → urgent revascularization. CSF drainage if T6-L1 endovascular. Inherits parent HTN-emergency framework.

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aneurysm-with-malperfusion suspected + anti-impulse + endovascular vs open plan articulated

Patient inputs (15)

Renal (flank pain, oliguria, hematuria); mesenteric (severe abdominal pain out of proportion to exam, lactate elevation); lower extremity (cold pulseless limb, pain); spinal (paraplegia, sensory loss) — drives revascularization priority

Most aneurysms occur >65 y; younger presentations suggest connective tissue disorder (Marfan, Loeys-Dietz, vEDS) — different surgical thresholds + genetic counseling

AAA male predominance 4:1; female AAA ruptures at smaller diameters (rupture risk per cm equivalent; women often considered for repair at 5.0 vs 5.5 cm)

Prior CTA / US findings establish baseline diameter; rapid expansion (≥5 mm/6mo or ≥10 mm/yr) is independent rupture risk per ACC/AHA 2022; prior repair history (anastomotic pseudoaneurysm pathway)

Marfan, Loeys-Dietz, vEDS, Turner — different surgical thresholds (Marfan repair at 5.0 cm root, Loeys-Dietz at 4.0-4.5 cm); 1st-degree relative with AAA = 10-fold increased risk (USPSTF screening); informs genetic counseling

Strongest modifiable AAA risk factor (smoking + male + age >65 = USPSTF AAA screening B); ongoing smoking accelerates expansion + repair complications

Sudden severe sharp back/flank pain in AAA suggests expansion/rupture; abdominal pain with pulsatile mass = AAA pain; chest pain radiating to back = thoracic; tearing radiating migrating = consider concomitant dissection

Branch malperfusion mapping: differential BP between arms suggests subclavian/innominate involvement; absent femoral/popliteal/DP/PT pulses suggest iliac/femoral compromise; pulse + capillary refill q15 min during pre-op stabilization

Renal malperfusion screen (Cr trend); mesenteric ischemia screen (lactate elevation); contrast nephropathy baseline; AKI severity for endovascular planning

Coronary involvement (RCA dissection extension if ascending aneurysm with extension); demand ischemia from hypovolemia/HTN; type 2 MI risk

Coagulopathy screen (rupture-related consumption); type & cross 6+ units PRBC + FFP + platelets for massive transfusion protocol; hemoglobin trend for ongoing bleed

Definitive imaging: diameter, morphology (fusiform vs saccular), intramural hematoma, contained rupture, branch involvement, distance from key anatomy (renal arteries, celiac, SMA, iliac); ACC/AHA 2022 Class I; preferred over MRA in acute setting

TTE rapid assessment of ascending aorta (extension), aortic insufficiency (proximal involvement), pericardial effusion (tamponade — suggests proximal extension to ascending), LV function

Universally elevated in this presentation; goal SBP 100-120 within 20-30 min AFTER HR <60; permissive hypotension until proximal control

GOAL HR <60 FIRST before vasodilator — anti-impulse paradigm (ACC/AHA 2022 Class I PMID 36066317) — applies equally to dissection + aneurysm-with-malperfusion

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (6)

6 need judgement
  • informationallife_threateningaortic_aneurysm_free_rupture_with_hemodynamic_collapse
    Free rupture (hemodynamic collapse, hemoperitoneum or hemothorax on imaging or transport hypotension) of aortic aneurysm with HTN background
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateninganeurysm_branch_malperfusion_mesenteric_ischemia
    Mesenteric ischemia (severe abdominal pain out of proportion to exam + lactate elevation + acidosis + diarrhea bloody) from aortic aneurysm visceral branch compromise
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateninganeurysm_spinal_cord_ischemia_post_t6_to_l1_endovascular
    New paraplegia or sensory loss post-T6-L1 endovascular repair (TEVAR or branched/fenestrated EVAR involving T6-L1 spinal arteries) — spinal cord ischemia from artery of Adamkiewicz disruption
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningconcomitant_dissection_identified_on_cta
    CTA shows aortic aneurysm WITH concomitant intimal flap dissection — dual pathology requiring both engines
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningrefractory_hr_or_bp_despite_max_anti_impulse
    Refractory HR >60 or SBP >120 despite maximum esmolol/labetalol + nicardipine — propagation risk
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereendoleak_post_evar_or_tevar_with_aneurysm_growth
    Endoleak detected on surveillance CTA post-EVAR/TEVAR (Type I, II, III, IV, or V) WITH aneurysm sac growth (≥5 mm) — indicates ongoing pressurization of sac
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Acute aortic aneurysm + malperfusion — anti-impulse paradigm: HR <60 FIRST (BB), THEN SBP 100-120 (vasodilator). Permissive hypotension until proximal control. Emergent endovascular (TEVAR/EVAR) or open repair per anatomy.
axis: aneurysm_with_malperfusion_anti_impulse_first
Selected axis "Acute aortic aneurysm + malperfusion — anti-impulse paradigm: HR <60 FIRST (BB), THEN SBP 100-120 (vasodilator). Permissive hypotension until proximal control. Emergent endovascular (TEVAR/EVAR) or open repair per anatomy." by default fallback (first axis)
  • esmolol
    first line
    beta1_blocker_short_acting
    500 µg/kg IV bolus then 50 µg/kg/min infusion, titrate by 25 µg/kg/min q5 min to HR <60 (max 300 µg/kg/min) • IV • continuous
    triggers: aortic_aneurysm_anti_impulse_FIRST
    ACC/AHA 2022 Class I — anti-impulse FIRST; ultra-short half-life allows fine titration; HR <60 within 5-10 min target; same paradigm as dissection
    rxcui 49737
  • labetalol
    first line
    mixed_alpha_beta_blocker
    20 mg IV q10 min (max 300 mg cumulative) OR 0.5-2 mg/min infusion • IV • bolus or infusion
    triggers: aortic_aneurysm_alt_anti_impulse, esmolol_unavailable
    ACC/AHA 2022 Class I alternative — mixed α/β provides combined HR + SBP control; useful when esmolol not on hand
    rxcui 6185
  • nicardipine
    first line
    dhp_ccb
    5 mg/h IV (ONLY after HR <60), titrate by 2.5 mg/h q5 min to SBP 100-120 within 20-30 min • IV • continuous
    triggers: aortic_aneurysm_after_BB_load
    ACC/AHA 2022 Class I — add ONLY after esmolol/labetalol established HR <60; SBP target 100-120 (permissive hypotension) until proximal control achieved
    rxcui 7396
  • nitroprusside
    second line
    arteriolar_vasodilator
    0.25-10 µg/kg/min IV (ONLY after HR <60 with BB) • IV • continuous
    triggers: aortic_aneurysm_refractory_after_nicardipine_max, normal_egfr
    Alternative vasodilator after BB; AVOID if eGFR <30 (cyanide); ACC/AHA 2022 acceptable adjunct
    rxcui 7476
  • AVOID isolated vasodilator without BB
    contraindication substitute
    do_not_use
    AVOID • N/A • N/A
    triggers: aortic_aneurysm_diagnosis
    Isolated vasodilator (nitroprusside, hydralazine, nicardipine without BB) increases dP/dt via reflex tachycardia → propagates aneurysm expansion / branch compromise (ACC/AHA 2022 Class III)
  • AVOID hydralazine
    contraindication substitute
    do_not_use
    AVOID • N/A • N/A
    triggers: aortic_aneurysm_diagnosis
    Hydralazine causes reflex tachycardia → increases dP/dt → propagation
  • fentanyl
    add on
    opioid_analgesic
    25-100 µg IV q5-10 min titrate • IV • PRN
    triggers: aneurysm_pain_with_sympathetic_drive
    Pain control reduces sympathetic drive (HR + dP/dt); IV opioid preferred for rapid titration
    rxcui 4337
  • massive transfusion protocol PRBC:FFP:platelets 1:1:1
    rescue
    blood_products
    6 units PRBC + 6 units FFP + 1 apheresis platelets initial pack • IV • continuous per blood bank protocol
    triggers: rupture_with_hemodynamic_collapse, massive_hemorrhage
    Hemorrhage control bridge to surgical repair; 1:1:1 ratio per PROPPR (Holcomb JAMA 2015 PMID 25647203); permissive hypotension (SBP 80-90) until surgical control
  • TEVAR for descending thoracic aneurysm
    first line
    endovascular_procedure
    Endovascular stent graft deployment per anatomy • procedural • one-time
    triggers: descending_thoracic_aneurysm_with_rupture_or_malperfusion_or_rapid_expansion
    IRAD precedent + INSTEAD-XL (Nienaber PMID 25840177) for thoracic descending; ACC/AHA 2022 Class I; CSF drainage protocol if T6-L1 for spinal cord protection
  • EVAR for abdominal aortic aneurysm
    first line
    endovascular_procedure
    Endovascular stent graft deployment per anatomy • procedural • one-time
    triggers: abdominal_aortic_aneurysm_with_rupture_or_rapid_expansion, infrarenal_anatomy_amenable_to_evar
    UK Trial (Greenhalgh PMID 16111932) + EVAR-1 (PMID 15978930) + DREAM (PMID 15469378) + OVER (PMID 19884600) — short-term mortality benefit over open repair for ruptured AAA; SVS 2024 + ESVS 2024 first-line for amenable anatomy
  • open repair for ascending aortic aneurysm or complex anatomy
    first line
    open_surgical_procedure
    Cardiothoracic or vascular surgical repair per anatomy • surgical • one-time
    triggers: ascending_aortic_aneurysm_rupture_or_expansion, complex_visceral_anatomy_not_amenable_to_endovascular, failed_endovascular_repair
    ACC/AHA 2022 Class I — open repair remains standard for ascending (mortality 50% if delayed); complex visceral anatomy beyond branched/fenestrated EVAR capability
  • CSF drainage protocol for T6-L1 endovascular
    add on
    spinal_cord_protection
    Lumbar drain pre-op + maintain CSF pressure <10 mmHg + MAP >85 for 48 h post-op • procedural • continuous 48 h post-op
    triggers: t6_to_l1_endovascular_repair_planned
    SVS 2024 + ESVS 2024 — spinal cord ischemia prevention; reduces paraplegia rate from 5-10% to <2%
  • branch revascularization per malperfusion target
    rescue
    endovascular_or_surgical_procedure
    Covered stent, fenestration, or surgical bypass per branch (renal, mesenteric, lower extremity, spinal) • procedural • as needed
    triggers: branch_malperfusion_renal_mesenteric_lower_extremity_spinal
    SVS 2024 + ESVS 2024 — restore branch flow within 6 h for mesenteric to prevent infarction; covered stent for renal; femoral-femoral bypass for lower extremity

outpatient playbook — drug actions (2)

  1. 1. continue lifelong BB ± ARB
    rxcui 7512
    Metoprolol XL + losartan at max-tolerated • PO • daily
    trigger: Post-aneurysm lifelong
    ACC/AHA 2022 Class I
  2. 2. continue statin
    rxcui 83367
    atorvastatin per ASCVD • PO • daily
    trigger: ASCVD secondary prevention
    2018 ACC/AHA Cholesterol

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Sudden severe back, flank, or abdominal pain in patient with known AAA or thoracic aneurysm + severe HTN — suspect rapid expansion / contained rupture / branch malperfusion; CTA showing aortic aneurysm (thoracic >5.5 cm or AAA >5.5 cm or rapidly expanding ≥5 mm/6mo) + intramural hematoma OR contained rupture OR branch malperfusion + severe HTN; Pulsatile abdominal mass on exam + new severe abdominal/back pain + severe HTN — AAA expansion or rupture pathway.

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Acute aortic aneurysm + malperfusion in hypertensive emergency (anti-impulse + emergent endovascular/open repair)** (cardio.hypertensive-emergency.acute-aortic-aneurysm-with-malperfusion.v1).
Scope: Acute aortic aneurysm + malperfusion in HTN crisis: aneurysm-driven (NOT dissection-driven) phenotype with rapid expansion / contained leak / branch compromise. Anti-impulse paradigm: HR <60 + dP/dt FIRST, THEN SBP 100-120 (permissive hypotension until proximal control). Endovascular FIRST for descending thoracic (TEVAR) + abdominal infrarenal (EVAR) per IRAD/SVS/ESVS 2024; OPEN REPAIR for ascending or complex anatomy. Branch malperfusion → urgent revascularization. CSF drainage if T6-L1 endovascular. Inherits parent HTN-emergency framework.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Acute aortic aneurysm + malperfusion — anti-impulse paradigm: HR <60 FIRST (BB), THEN SBP 100-120 (vasodilator). Permissive hypotension until proximal control. Emergent endovascular (TEVAR/EVAR) or open repair per anatomy.**.
1. esmolol 500 µg/kg IV bolus then 50 µg/kg/min infusion, titrate by 25 µg/kg/min q5 min to HR <60 (max 300 µg/kg/min) IV continuous (beta1_blocker_short_acting, first line) — ACC/AHA 2022 Class I — anti-impulse FIRST; ultra-short half-life allows fine titration; HR <60 within 5-10 min target; same paradigm as dissection
2. labetalol 20 mg IV q10 min (max 300 mg cumulative) OR 0.5-2 mg/min infusion IV bolus or infusion (mixed_alpha_beta_blocker, first line) — ACC/AHA 2022 Class I alternative — mixed α/β provides combined HR + SBP control; useful when esmolol not on hand
3. nicardipine 5 mg/h IV (ONLY after HR <60), titrate by 2.5 mg/h q5 min to SBP 100-120 within 20-30 min IV continuous (dhp_ccb, first line) — ACC/AHA 2022 Class I — add ONLY after esmolol/labetalol established HR <60; SBP target 100-120 (permissive hypotension) until proximal control achieved
4. nitroprusside 0.25-10 µg/kg/min IV (ONLY after HR <60 with BB) IV continuous (arteriolar_vasodilator, second line) — Alternative vasodilator after BB; AVOID if eGFR <30 (cyanide); ACC/AHA 2022 acceptable adjunct
5. AVOID isolated vasodilator without BB AVOID N/A N/A (do_not_use, contraindication substitute) — Isolated vasodilator (nitroprusside, hydralazine, nicardipine without BB) increases dP/dt via reflex tachycardia → propagates aneurysm expansion / branch compromise (ACC/AHA 2022 Class III)
6. AVOID hydralazine AVOID N/A N/A (do_not_use, contraindication substitute) — Hydralazine causes reflex tachycardia → increases dP/dt → propagation
7. fentanyl 25-100 µg IV q5-10 min titrate IV PRN (opioid_analgesic, add on) — Pain control reduces sympathetic drive (HR + dP/dt); IV opioid preferred for rapid titration
8. massive transfusion protocol PRBC:FFP:platelets 1:1:1 6 units PRBC + 6 units FFP + 1 apheresis platelets initial pack IV continuous per blood bank protocol (blood_products, rescue) — Hemorrhage control bridge to surgical repair; 1:1:1 ratio per PROPPR (Holcomb JAMA 2015 PMID 25647203); permissive hypotension (SBP 80-90) until surgical control
9. TEVAR for descending thoracic aneurysm Endovascular stent graft deployment per anatomy procedural one-time (endovascular_procedure, first line) — IRAD precedent + INSTEAD-XL (Nienaber PMID 25840177) for thoracic descending; ACC/AHA 2022 Class I; CSF drainage protocol if T6-L1 for spinal cord protection
10. EVAR for abdominal aortic aneurysm Endovascular stent graft deployment per anatomy procedural one-time (endovascular_procedure, first line) — UK Trial (Greenhalgh PMID 16111932) + EVAR-1 (PMID 15978930) + DREAM (PMID 15469378) + OVER (PMID 19884600) — short-term mortality benefit over open repair for ruptured AAA; SVS 2024 + ESVS 2024 first-line for amenable anatomy
11. open repair for ascending aortic aneurysm or complex anatomy Cardiothoracic or vascular surgical repair per anatomy surgical one-time (open_surgical_procedure, first line) — ACC/AHA 2022 Class I — open repair remains standard for ascending (mortality 50% if delayed); complex visceral anatomy beyond branched/fenestrated EVAR capability
12. CSF drainage protocol for T6-L1 endovascular Lumbar drain pre-op + maintain CSF pressure <10 mmHg + MAP >85 for 48 h post-op procedural continuous 48 h post-op (spinal_cord_protection, add on) — SVS 2024 + ESVS 2024 — spinal cord ischemia prevention; reduces paraplegia rate from 5-10% to <2%
13. branch revascularization per malperfusion target Covered stent, fenestration, or surgical bypass per branch (renal, mesenteric, lower extremity, spinal) procedural as needed (endovascular_or_surgical_procedure, rescue) — SVS 2024 + ESVS 2024 — restore branch flow within 6 h for mesenteric to prevent infarction; covered stent for renal; femoral-femoral bypass for lower extremity

Setting playbook (outpatient) — Lifetime aortic surveillance with annual CTA, lifelong BB ± ARB + statin, strict BP <130/80, smoking cessation maintenance, family screening completion, activity restriction, recurrence symptom education
14. continue lifelong BB ± ARB Metoprolol XL + losartan at max-tolerated PO daily — Post-aneurysm lifelong (ACC/AHA 2022 Class I)
15. continue statin atorvastatin per ASCVD PO daily — ASCVD secondary prevention (2018 ACC/AHA Cholesterol)

Non-pharmacologic actions:
- Lifelong activity restriction (no heavy isometric lifting, no extreme exertion)
- Annual CTA
- Family screening completion
- Smoking cessation maintenance lifelong
- Healthy diet (DASH or Mediterranean)

AVOID / contraindication checks:
- NEVER_isolated_vasodilator_in_aneurysm_dpdt_propagation_risk (ACC/AHA 2022 Class III)
- Hydralazine_reflex_tachy_avoid (ACC/AHA 2022)
- Nitroprusside_cyanide_avoid_if_egfr_below_30 (ACC/AHA 2022)
- Hr_below_60_FIRST_before_vasodilator (ACC/AHA 2022 Class I)
- Permissive_hypotension_sbp_100_to_120_until_proximal_control_achieved (ACC/AHA 2022)
- Csf_drainage_for_t6_to_l1_endovascular_to_prevent_paraplegia (SVS 2024 + ESVS 2024)
- Massive_transfusion_protocol_1_to_1_to_1_for_rupture (PROPPR PMID 25647203)
- Open_repair_for_ascending_aneurysm_rupture_endovascular_not_indicated (ACC/AHA 2022)
- Decision:tevar_for_descending_thoracic_evar_for_abdominal_infrarenal (IRAD + UK Trial + EVAR 1 + DREAM + OVER)
- Decision:branched_fenestrated_evar_for_complex_visceral_anatomy (SVS 2024 + ESVS 2024)
- Decision:branch_revascularization_within_6h_for_mesenteric_to_prevent_infarction
- Decision:run_dissection_dossier_in_parallel_if_concomitant_intimal_flap_identified
- Caution:resume_anticoagulation_only_after_definitive_repair_in_aneurysm_with_active_rupture

Monitoring

Regimen monitoring:
- arterial line q5min BP HR (ACC/AHA 2022)
- serial CTA q6-24h for extension or endoleak (ACC/AHA 2022; SVS 2024)
- daily exam for pulse change neuro deficit abdominal pain (ACC/AHA 2022)
- serial Cr q4-6h for renal malperfusion or contrast nephropathy (ACC/AHA 2022)
- serial lactate for mesenteric malperfusion (ACC/AHA 2022)
- serial neuro exam for carotid or spinal branch involvement (ACC/AHA 2022)
- csf pressure monitoring x 48h post op if t6 to l1 endovascular (SVS 2024)
- hemoglobin trend q4h during active bleed or post repair (PROPPR)
- wound exam daily post open repair for infection

Setting (outpatient) monitoring:
- Annual CTA
- Quarterly BP review
- Annual lipid + A1c

Follow-up plan: Lifetime aortic surveillance: post-EVAR/TEVAR CTA at 1, 6, 12 mo then annually (endoleak surveillance); for unrepaired remaining aneurysm sites q6-12 mo per size; lifelong BB ± ARB to BP <130/80 (ACC/AHA 2022); smoking cessation (strongest modifiable progression risk); statin per ASCVD; genetic counseling if Marfan/Loeys-Dietz/vEDS; family screening per USPSTF (AAA in 1st-degree male >65 ever-smoker); cardiac surgery follow-up if open repair
- Close-out criterion: outpatient surveillance + BB + smoking cessation + family screening + genetic plan documented

Monitoring phase: Arterial line + q5-15 min BP + HR; serial CTA q6-24 h to detect extension or endoleak post-EVAR/TEVAR; daily exam for new pulse change, neuro deficit (spinal cord ischemia post-T6-L1 endovascular surveillance), abdominal pain (mesenteric ischemia recurrence); serial Cr + lactate for branch malperfusion + AKI; spinal cord protocol (CSF drainage to ICP <10 mmHg, MAP >85 if T6-L1)

Disposition

Current setting: outpatient — Lifetime aortic surveillance with annual CTA, lifelong BB ± ARB + statin, strict BP <130/80, smoking cessation maintenance, family screening completion, activity restriction, recurrence symptom education

Disposition criteria:
- Long-term continuation; cross-link to vasc.aaa.v1 for AAA-specific lifelong management; cross-link to cardio.aortic-dissection.core.v1 if dissection arose post-repair; cross-link to cardio.htn.core.v1 for chronic HTN management

Escalation triggers (move to higher acuity):
- Recurrent pain → STAT CTA + ED
- New aneurysm site on CTA (different segment) → vascular surgery intervention threshold per ACC/AHA 2022
- Endoleak detected on surveillance → vascular IR re-intervention
- Family member screening positive → counseling + surveillance

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Free rupture (hemodynamic collapse, hemoperitoneum or hemothorax on imaging or transport hypotension) of aortic aneurysm with HTN background
- [LIFE_THREATENING] Mesenteric ischemia (severe abdominal pain out of proportion to exam + lactate elevation + acidosis + diarrhea bloody) from aortic aneurysm visceral branch compromise
- [LIFE_THREATENING] New paraplegia or sensory loss post-T6-L1 endovascular repair (TEVAR or branched/fenestrated EVAR involving T6-L1 spinal arteries) — spinal cord ischemia from artery of Adamkiewicz disruption

Citations

- 2022 ACC/AHA Aortic Disease Guideline (Isselbacher PMID 36066317) + SVS 2024 Abdominal Aortic Aneurysm Guideline + ESVS 2024 Abdominal Aortic Aneurysm Guidelines + 2025 ACC/AHA HTN Guideline + ESC/ESH 2024 HTN (Mancia PMID 38613493) [PMID:36066317](https://pubmed.ncbi.nlm.nih.gov/36066317/)
- Cited evidence (PMID 17307915) [PMID:17307915](https://pubmed.ncbi.nlm.nih.gov/17307915/)
- Cited evidence (PMID 25840177) [PMID:25840177](https://pubmed.ncbi.nlm.nih.gov/25840177/)
- Cited evidence (PMID 16111932) [PMID:16111932](https://pubmed.ncbi.nlm.nih.gov/16111932/)
- Cited evidence (PMID 15978930) [PMID:15978930](https://pubmed.ncbi.nlm.nih.gov/15978930/)

Last reconciled with current guidelines: 2026-05-15.
References
  • 2022 ACC/AHA Aortic Disease Guideline (Isselbacher PMID 36066317) + SVS 2024 Abdominal Aortic Aneurysm Guideline + ESVS 2024 Abdominal Aortic Aneurysm Guidelines + 2025 ACC/AHA HTN Guideline + ESC/ESH 2024 HTN (Mancia PMID 38613493) — PMID:36066317
  • Cited evidence (PMID 17307915) — PMID:17307915
  • Cited evidence (PMID 25840177) — PMID:25840177
  • Cited evidence (PMID 16111932) — PMID:16111932
  • Cited evidence (PMID 15978930) — PMID:15978930