|
|
| (10 intermediate revisions by one other user not shown) |
| Line 1: |
Line 1: |
| __NOTOC__
| |
| {{Thoracic Aortic Disease}}
| |
|
| |
|
| ==Overview==
| |
| ==ACC/AHA Guidelines - Guidelines for the General Medical Treatment and Risk Factor Management for Patients With Thoracic Aortic Disease (DO NOT EDIT) <ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780 }} </ref>==
| |
| ===Recommendation for Smoking Cessation===
| |
| {|class="wikitable"
| |
| |-
| |
| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| |
| |-
| |
| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home are recommended. Follow-up, referral to special programs, and/or pharmacotherapy (including nicotine replacement, buproprion, or varenicline) is useful, as is adopting a stepwise strategy aimed at smoking cessation (the 5 A’s are Ask, Advise, Assess, Assist, and Arrange). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki>
| |
| |}
| |
|
| |
| ===Recommendation for Dyslipidemia===
| |
| {|class="wikitable"
| |
| |-
| |
| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| |
| |-
| |
| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Treatment with a statin to achieve a target LDL cholesterol of less than 70 mg/dL is reasonable for patients with a coronary heart disease risk equivalent such as noncoronary atherosclerotic disease, atherosclerotic aortic aneurysm, and coexistent coronary heart disease at high risk for coronary ischemic events. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
| |
| |}
| |
|
| |
| ==ACC/AHA Guidelines - Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Organ Protection (DO NOT EDIT) <ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780 }} </ref>==
| |
|
| |
| ===Class I Recommendations===
| |
| ====Spinal cord protection during Descending aortic open surgical and endovascular repairs====
| |
| {{cquote|
| |
| 1. Cerebrospinal fluid drainage is recommended as a spinal cord protective strategy in open and endovascular thoracic aortic repair for patients at high risk of spinal cord ischemic injury. (Level of Evidence: B)}}
| |
|
| |
| ===Class III Recommendations===
| |
| ====Renal protection during Descending aortic open surgical and endovascular repairs====
| |
| {{cquote|
| |
| 1. Furosemide, mannitol, or dopamine should not be given solely for the purpose of renal protection in descending aortic repairs. (Level of Evidence: B)}}
| |
|
| |
| ===Class IIa Recommendations===
| |
| ====Brain protection during Ascending aortic and Transverse aortic arch surgery====
| |
| {{cquote|
| |
| 1. Deep hypothermic circulatory arrest, selective antegrade brain perfusion, and retrograde brain perfusion are techniques that alone or in combination are reasonable to minimize brain injury during surgical repairs of the ascending aorta and transverse aortic arch. Institutional experience is an important factor in selecting these techniques. (Level of Evidence: B)}}
| |
|
| |
| ====Spinal cord protection during Descending aortic open surgical and endovascular repairs====
| |
| {{cquote|
| |
| 1. Spinal cord perfusion pressure optimization using techniques, such as proximal aortic pressure maintenance and distal aortic perfusion, is reasonable as an integral part of the surgical, anesthetic, and perfusion strategy in open and endovascular thoracic aortic repair patients at high risk of spinal cord ischemic injury. Institutional experience is an important factor in selecting these techniques. (Level of Evidence: B)
| |
|
| |
| 2. Moderate systemic hypothermia is reasonable for protection of the spinal cord during open repairs of the descending thoracic aorta. (Level of Evidence: B)}}
| |
|
| |
| ===Class IIb Recommendations===
| |
| ====Spinal cord protection during Descending aortic open surgical and endovascular repairs====
| |
| {{cquote|
| |
| 1. Adjunctive techniques to increase the tolerance of the spinal cord to impaired perfusion may be considered during open and endovascular thoracic aortic repair for patients at high risk of spinal cord injury. These include distal perfusion, epidural irrigation with hypothermic solutions, high-dose systemic glucocorticoids, osmotic diuresis with mannitol, intrathecal papaverine, and cellular metabolic suppression with anesthetic agents. (Level of Evidence: B)
| |
|
| |
| 2. Neurophysiological monitoring of the spinal cord (somatosensory evoked potentials or motor evoked potentials) may be considered as a strategy to detect spinal cord ischemia and to guide reimplantation of intercostal arteries and/or hemodynamic optimization to prevent or treat spinal cord ischemia. (Level of Evidence: B)}}
| |
|
| |
| ====Renal protection during Descending aortic open surgical and endovascular repairs====
| |
| {{cquote|
| |
| 1. Preoperative hydration and intraoperative mannitol administration may be reasonable strategies for preservation of renal function in open repairs of the descending aorta.(Level of Evidence: C)
| |
|
| |
| 2. During thoracoabdominal or descending aortic repairs with exposure of the renal arteries, renal protection by either cold crystalloid or blood perfusion may be considered. (Level of Evidence: B)}}
| |
|
| |
| ==References==
| |
| {{Reflist|2}}
| |
|
| |
| [[Category:Needs content]]
| |
| [[Category:Cardiology]]
| |