Thoracic Endovascular Aneurysm Repair
Key Points
Key Points
- Thoracic aortic diseases, including disease of the descending thoracic aorta (DTA), are significant causes of death in the United States.
- Thoracic endovascular aneurysm repair (TEVAR) should be the primary method of repair in both the elective and emergent setting based on improved short- and mid-term mortality, as well as decreased morbidity.
Diagnosis
...Diagnosis...
...nts considered at low or intermediate risk for...
...sidered at high risk for symptomatic TAA or acu...
...EVAR cases, we suggest assessment...
...is being considered, we recommend fine-cut (≤0....
...recommend routine use of three-dimen...
...gest contrast-enhanced MRA for preoperative p...
...recommend intravascular ultrasound (IVUS) use...
...nes of the thoracic aorta...
.... Classification of the aortic arc...
Treatment
...Treatment...
...rtension is a modifiable risk factor for the...
...mmend interventions for smoking cess...
...ts who could undergo either technique...
...VAR in asymptomatic patients with a descending T...
...est using higher aortic diameter thresholds...
...se of the dynamic nature of isolated...
...end TEVAR in patients with IMH or penetrating ao...
...ggest TEVAR in selected cases of asymptom...
...suggest TEVAR for symptomatic myc...
...ncreasing perfusion pressure through...
...prophylactic cerebrospinal fluid (CSF) drai...
For elective TEVAR of a TAA where coverage of...
...n whom the anatomy to be treated compromises pe...
...s with acute thoracic emergencies, w...
...reprocedural TEVAR planning to includ...
...commend nonionic, hypo-osmolar contrast...
...nding on the patient’s corporal...
...gest the use of on-table mapping software opti...
To decrease the risk of atheroembolization, we...
...inimizing the dwelling time of large or oc...
...e recommend pre-emptive superior mese...
...ion of high risk for CA territory ischemi...
...f an open approach for access is used, we recommen...
...ing ultrasound guidance for percutaneous access to...
...ommend that percutaneous access for TEV...
We recommend the use of iliac conduits or di...
...gest that endoconduits to facilitate access...
We recommend TEVAR over open repair for...
...ntrast-enhanced CT scanning at one month and twe...