Favorable Outcomes in Octogenarians with Hostile Neck undergoing Endovascular Repair using EndoAnchors.

Spontaneous rupture of a common iliac artery aneurysm into the common iliac vein is a rare phenomenon. We report the case of a 68 year old man admitted with acute cardiac failure and massive pulmonary embolism as a complication of a spontaneous ilio-iliac fistula, secondary to aneurysmal rupture. The aneurysm was successfully excluded using an aorto-uni-iliac stent graft. No complications were noted at 9 months follow-up. Arteriovenous fistulae should be considered in patients with aortic or iliac aneurysms who develop a pulmonary embolism or symptoms of venous congestion. Endovascular repair of these pathologies is a feasible therapeutic option; however long term results remain unknown.

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Outcome of carotid endarterectomy under local anaesthesia with respect to the patients’ risk profile

VASA ◽

10.1024/0301-1526.38.3.225 ◽

2009 ◽

Vol 38 (3) ◽

pp. 225-233 ◽

Cited By ~ 2

Author(s):

Aleksic ◽

Luebke ◽

Brunkwall

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Carotid Endarterectomy ◽

Complication Rate ◽

Local Anaesthesia ◽

High Risk Group ◽

High Risk Patients ◽

Hostile Neck ◽

Risk Patients ◽

Angioplasty And Stenting

Background: In the present study the perioperative complication rate is compared between high- and low-risk patients when carotid endarterectomy (CEA) is routinely performed under local anaesthesia (LA). Patients and methods: From January 2000 through June 2008 1220 consecutive patients underwent CEA under LA. High-risk patients fulfilled at least one of the following characteristics: ASA 4 classification, “hostile neck”, recurrent ICA stenosis, contralateral ICA occlusion, age ≥ 80 years. The combined complication rate comprised any new neurological deficit (TIA or stroke), myocardial infarction or death within 30 days after CEA, which was compared between patient groups. Results: Overall 309 patients (25%) were attributed to the high-risk group, which differed significantly regarding sex distribution (more males: 70% vs. 63%, p = 0,011), neurological presentation (more asymptomatic: 72% vs. 62%, p = 0,001) and shunt necessity (33% vs. 14%, p < 0,001). In 32 patients 17 TIAs and 15 strokes were observed. In 3 patients a myocardial infarction occurred. Death occurred in one patient following a stroke and in another patient following myocardial infarction, leading to a combined complication rate of 2,9% (35/1220). In the multivariate analysis only previous neurological symptomatology (OR 2,85, 95% CI 1,38-5,91) and intraoperative shunting (OR 5,57, 95% CI 2,69-11,55) were identified as independent risk factors for an increased combined complication rate. Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA.

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Successful Endovascular Repair of a Leaking Abdominal Aortic Aneurysm under Local Anesthesia

Swiss Surgery ◽

10.1024/1023-9332.7.2.86 ◽

2001 ◽

Vol 7 (2) ◽

pp. 86-89 ◽

Cited By ~ 17

Author(s):

Lachat ◽

Pfammatter ◽

Bernard ◽

Jaggy ◽

Vogt ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Ct Scan ◽

Local Anesthesia ◽

Endovascular Repair ◽

Anesthetic Management ◽

High Risk Patient ◽

Invasive Technique ◽

Chronic Obstructive ◽

Abdominal Aortic

Local anesthesia is a safe and less invasive anesthetic management for the endovascular approach to elective aortic aneurysm. We have successfully extended the indication of local anesthesia to a high-risk patient with leaking aneurysm and stable hemodynamics. Patient and methods: A 86 year old patient with renal insufficiency due to longstanding hypertension, coronary artery and chronic obstructive lung disease was transferred to our hospital with a leaking abdominal aortic aneurysm. Stable hemodynamics allowed to perform a fast CT scan, that confirmed the feasibility of endovascular repair. A bifurcated endograft (24mm x 12mm x 153mm) was implanted under local anesthesia. Results: The procedure was completed within 85 minutes without problems. The complete sealing of the aneurysm was confirmed by CT scan on the third postoperative day. Twenty months later, the patient is doing well and radiological control confirmed complete exclusion of the aneurysm. Discussion: The endoluminal treatment is a minimally invasive technique. It's feasibility can be rapidly assessed by CT scan. The transfemoral implantation can be performed under local anesthesia provided that hemodynamics are stable. This anesthetic management seems to be particularly advantageous for leaking abdominal aortic aneurysm since it doesn't change the hemodynamic situation in contrast to general anesthesia. Hemodynamic instability, abdominal distension or tenderness may indicate intraperitoneal rupture and conversion to open graft repair should be performed without delay.

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