LAUSR

In 1953, Bahnson reported the first successful excision and homograft repair of a ruptured abdominal aortic aneurysm (rAAA). During the ensuing six decades, advancements in perioperative management, device development, and clinical imaging have enabled progress in the care of these patients. Indeed, screening for AAA in at-risk populations has led to a reduced risk of aortic rupture. Unfortunately, for patients in whom rupture does occur, morbidity andmortality rates remain high, and decreasing the time to intervention is paramount for improving the odds of survival. As surgical expertise, related technologies, and ancillary services necessary for intervention and recovery become increasingly regionalized, rapid patient triage and transfer to centers that can provide optimal care represent a current critical challenge. In this issue of the Journal, Mell et al present the Western Vascular Society (WVS) guidelines for the transfer of patients with rAAA. Having previously noted substantial variability in transfer criteria, management, and available resources at the treating center, the WVS has proposed the first consensus-based recommendations in the United States for the management of patients with rAAA presenting to facilities that are unable to provide definitive care. The aim of such guidelines is to initiate a broad-based evaluation of this issue that will lead to the standardization of best practices. In the process, opportunities for further investigation have been identified. Nonetheless, until results from further studies are available to provide evidencebased optimization of these recommendations, next steps should focus on developing systems of care that promote the integration and alignment of service-providing entities within a region to deliver disease-specific quality care. Such systems have been established for management of ST-elevation myocardial infarction, ischemic stroke, and trauma care and have proved beneficial in managing these