Continuous Spinal Anaesthesia for Endovascular Repair of Abdominal Aortic Aneurysm in High-Risk Patient

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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Eight-Year Follow-Up of a High-Risk Patient Treated for Crawford Type II Thoracoabdominal Aortic Aneurysm (TAAA) with a Multistage Hybrid Open-Endovascular Repair

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.cr.12.01924 ◽

2013 ◽

Vol 19 (2) ◽

pp. 166-169

Author(s):

Dariusz Janczak ◽

Jerzy Garcarek ◽

Robert Bogdanik ◽

Tomasz Szydelko ◽

Mariusz Chabowski ◽

...

Keyword(s):

High Risk ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

High Risk Patient ◽

Thoracoabdominal Aortic Aneurysm ◽

Risk Patient ◽

Type Ii

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Staged hybrid open and endovascular exclusion of a symptomatic thoracoabdominal aortic aneurysm in a high-risk patient

Vascular ◽

10.1177/1708538113492515 ◽

2013 ◽

Vol 22 (4) ◽

pp. 280-285 ◽

Cited By ~ 1

Author(s):

Christine Chung ◽

Rajesh Malik ◽

Michael Marin ◽

Peter Faries ◽

Sharif Ellozy

Keyword(s):

High Risk ◽

Aortic Aneurysm ◽

Hybrid Approach ◽

High Risk Patient ◽

Thoracoabdominal Aortic Aneurysm ◽

The Elderly ◽

Aortic Aneurysms ◽

Risk Patient ◽

Abdominal Aortic ◽

Thoracic Aneurysms

Thoracoabdominal aortic aneurysms have a higher prevalence in the elderly, who are often poor surgical candidates. These extensive aneurysms may be lethal if left untreated. Conventional open repair has proven to be a major task, involving cardiopulmonary bypass, aortic cross-clamping and expeditious repair of an inaccessible structure involving two body cavities. Endovascular repair has become a viable option to treat isolated descending thoracic aneurysms and infrarenal abdominal aortic aneurysms. However, endovascular techniques alone have been less applicable for treating complex aortic aneurysms, including those involving visceral vessels. Therefore, a hybrid open and endovascular approach with visceral debranching has become an increasingly favorable alternative for patients with these complex conditions. We report a case in which a staged hybrid approach was used for successful exclusion of an extensive thoracoabdominal aortic aneurysm in a symptomatic, high-risk patient who would not have been an appropriate candidate for open surgical repair.

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