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
...iagnosis
...nts considered at low or intermediate risk for...
...considered at high risk for symptoma...
...ive TEVAR cases, we suggest assessment of left v...
...being considered, we recommend fine-c...
...end routine use of three-dimensional center...
...contrast-enhanced MRA for preoperative pla...
...intravascular ultrasound (IVUS) use in TEVAR...
...ure 1. Zones of the thoracic a...
...e 2. Classification of the aortic...
Treatment
...eatment...
...n is a modifiable risk factor for the develop...
...ecommend interventions for smoking cessation...
...who could undergo either technique (within t...
...AR in asymptomatic patients with a descend...
...st using higher aortic diameter thresholds...
...e of the dynamic nature of isolated intra...
...mmend TEVAR in patients with IMH or penetr...
...suggest TEVAR in selected cases of asym...
...TEVAR for symptomatic mycotic/infected...
...creasing perfusion pressure through controlled...
...phylactic cerebrospinal fluid (CSF) drainage for...
For elective TEVAR of a TAA where coverage of t...
...patients in whom the anatomy to be t...
...r patients with acute thoracic emergencies, wher...
...ecommend preprocedural TEVAR planning to incl...
...nd nonionic, hypo-osmolar contrast m...
...e patient’s corporal density and the...
...use of on-table mapping software options on fixed-...
...risk of atheroembolization, we recom...
...nimizing the dwelling time of large...
...ommend pre-emptive superior mesenteric artery...
...ipation of high risk for CA territo...
If an open approach for access is used, we rec...
...e recommend using ultrasound guidance for percut...
...at percutaneous access for TEVAR is safe and an a...
...he use of iliac conduits or direct ilia...
...uggest that endoconduits to facilita...
...commend TEVAR over open repair for the t...
...mmend contrast-enhanced CT scanning at one month...