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
