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
