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Diagnosis and Management of Aortic Disease

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54 Treatment 6.5.4.2. Open Versus Endovascular Repair of TAAA COR LOE Recommendations Ruptured TAAA 1 B-NR 1. In patients with ruptured TAAA requiring intervention, open repair is recommended. 2b C-LD 2. In patients with ruptured TAAA requiring intervention, provided that the patient is hemodynamically stable, endovascular repair may be reasonable in centers with endovascular expertise and access to appropriate endovascular stent grafts. Intact TAAA 1 C-LD 3. In patients with Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome and intact TAAA requiring intervention, open repair is recommended over endovascular repair. 2b B-NR 4. In patients with intact degenerative TAAA and suitable anatomy, endovascular repair with fenestrated stent grafts, branched stent grafts, or both may be considered in centers with endovascular expertise and access to appropriate endovascular stent grafts. 6.5.4.3. TAAA Spinal Cord Protection COR LOE Recommendations 1 A 1. In patients undergoing open TAAA repair who are at high risk for SCI, cerebrospinal fluid drainage is recommended to reduce the incidence of temporary SCI, permanent SCI, or both. 1 B-NR 2. In patients who experience delayed spinal cord dysfunction after either open or endovascular TAAA repair, timely measures to optimize spinal cord perfusion and decrease intrathecal pressure are recommended (Table 20). Table 20. Measures to Optimize Spinal Cord and End-Organ Perfusion Cardioversion for tachyarrhythmias Insertion of cerebrospinal fluid drain Increase mean arterial pressure to >100 mm Hg Transfuse to a hemoglobin >10 g/dL Volume resuscitation

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