Thoracic aortic disease secondary prevention: Difference between revisions

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1. Furosemide, mannitol, or dopamine should not be given solely for the purpose of renal protection in descending aortic repairs. (Level of Evidence: B)}}
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===
===Class IIb Recommendations===
===Class IIb Recommendations===
====Renal protection during Descending aortic open surgical and endovascular repairs====
====Renal protection during Descending aortic open surgical and endovascular repairs====

Revision as of 15:19, 10 October 2012


Overview

ACC/AHA Guidelines - Guidelines for the General Medical Treatment and Risk Factor Management for Patients With Thoracic Aortic Disease (DO NOT EDIT) [1]

Recommendation for Smoking Cessation

Class I
"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). (Level of Evidence: B) "

Recommendation for Dyslipidemia

Class IIa
"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. (Level of Evidence: A)"

ACC/AHA Guidelines - Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Organ Protection (DO NOT EDIT) [1]

Class III Recommendations

Renal protection during Descending aortic open surgical and endovascular repairs

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 IIb Recommendations

Renal protection during Descending aortic open surgical and endovascular repairs

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

  1. 1.0 1.1 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). "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". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.