51
6.5.3.2. Endovascular Versus Open Repair of Descending TAA
COR LOE
Recommendations
1 B-NR 1. In patients without Marfan syndrome, Loeys-Dietz syndrome,
or vascular Ehlers-Danlos syndrome, who have a descending
TAA that meets criteria for intervention and anatomy suitable
for endovascular repair, TEVAR is recommended over open
surgery.
1 B-NR 2. In patients with a descending TAA that meets criteria for
repair with TEVAR, who have smaller or diseased access
vessels, considerations for alternative vascular access are
recommended.
2a B-NR 3. In patients with a descending TAA that meets criteria for
intervention, who have anatomy unsuitable for endovascular
repair, and who are without significant comorbidities and
have a life expectancy of at least 10 years, open surgical repair
is reasonable.
Table 18. Patient Characteristics Associated With Increased
Perioperative Morbidity and Mortality After Open
and Endovascular Repair of Descending TAA
Open Surgical Repair Endovascular Repair
Advanced age
65–74 y (OR, 1.8; 95% CI, 1.4–2.4; P<0.001)
≥75 y (OR, 2.6; 95% CI, 2.0–3.5; P<0.001)
Functional dependence
Preoperative renal insufficiency
(stage 3 or greater CKD) or hemodialysis
oracoabdominal aortic aneurysm
extent
COPD and FEV1 ≤50% predicted Pulmonary disease
Previous stroke Need for iliac access
Zone 1/2 landing for thoracic stent gra
