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6.5.4.4. TAAA Renal and Visceral Organ Protection
COR LOE
Recommendations
1 A 1. In patients undergoing open repair of TAAA involving the
renal arteries, cold blood or crystalloid renal perfusion is
recommended to provide effective protection against renal
injury.
1 B-NR 2. In patients undergoing open or endovascular TAAA repair
who have end-organ ischemia or significant stenoses from
atherosclerotic visceral or renal artery disease, additional
revascularization procedures are recommended.
6.5.5.1. Access During Endovascular Repair of AAA
COR LOE
Recommendation
1 B-R 1. In patients undergoing endovascular repair of AAA who have
suitable common femoral artery anatomy, ultrasound-guided
percutaneous access and closure is recommended over open
cutdown to reduce operative time, blood loss, length of stay,
time to wound healing, and pain.
6.5.5.2. Repair of Ruptured AAA
COR LOE
Recommendations
1 B-R 1. In patients presenting with ruptured AAA who are
hemodynamically stable, CT imaging is recommended to
evaluate whether the AAA is amenable to endovascular repair.
1 B-R 2. In patients presenting with ruptured AAA who have suitable
anatomy, endovascular repair is recommended over open
repair to reduce the risk of morbidity and mortality.
2a B-NR 3. In patients undergoing endovascular repair for ruptured AAA,
local anesthesia is preferred to general anesthesia to reduce
risk of perioperative mortality.
2a C-LD 4. In patients with ruptured AAA, permissive hypotension can
be beneficial to decrease the rate of bleeding.
