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Diagnosis and Management of Aortic Disease

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53 6.5.3.6. Access Issues for TEVAR in Descending TAA COR LOE Recommendations 1 B-NR 1. In patients with descending TAA undergoing TEVAR, review of preoperative CTA of the iliofemoral vessels should be performed to evaluate access. 1 B-NR 2. In patients with descending TAA undergoing TEVAR, if iliac access is marginal or inadequate to prevent access- related complications, the use of alternative conduits is recommended. 2a B-NR 3. In patients with descending TAA undergoing TEVAR who have suitable anatomy, total percutaneous femoral access is a reasonable alternative to open surgical cutdown to avoid access-related complications. 6.5.4.1. Size Thresholds for Open Surgical Repair of TAAA COR LOE Recommendations 1 B-NR 1. In patients with intact degenerative TAAA, repair is recommended when the diameter is ≥6.0 cm. 2a B-NR 2. In patients with intact degenerative TAAA, repair is reasonable when the diameter is ≥5.5 cm and the repair is performed by experienced surgeons in a Multidisciplinary Aortic Team. 2a B-NR 3. In patients with intact degenerative TAAA who have features associated with an increased risk of rupture (Table 19), repair is reasonable when the diameter is <5.5 cm. Table 19. Features Associated With an Increased Risk of TAAA Rupture Rapid growth (confirmed increase in diameter of ≥0.5 cm/y) Symptomatic aneurysm Significant change in aneurysm appearance Saccular aneurysm or presence of penetrating atherosclerotic ulcers

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