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Online ISSN 1827-1847
Nessi F. 1, Ferrero E. 1, Gaggiano A. 1, Maggio D. 1, Ferri M. 1, Viazzo A. 1, Berardi G. 1, Piazza S. 1, Cumbo P. 1, Fadde M. 2, Lojacono N. 2, Bianchi A. 2, Verdecchia C. 2
1 Department of Cardiac and Vascular Disease Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
2 Department of Cardiac and Vascular Disease Anesthesia, Resuscitation and Intensive Care Unit Mauriziano Umberto I Hospital, Turin, Italy
From January 2000 to August 2006, 623 patients were treated for abdominal infrarenal aortic aneurysm (AAA) at the Vascular and Endovascular Surgery Department: 114 patients underwent an endovascular aneurysm repair (EVAR) and 509 an “open” surgery under general anesthesia. In nine cases it was necessary to carry out a deferred EVAR conversion to open repair: eigth cases were treated under general anaesthesia, one case by open repair surgery under combined spinal and epidural anaesthesia (CSEA). This article describes the clinical case of a 75-year-old male, treated five years before with a bifurcated aortic endoprosthesis, with an AAA with a maximum diameter of 8 cm, detected at the last computed tomography follow-up. For the high risk of postoperative complications due to respiratory failure (severe chronic obstructive pulmonary disease, COPD) an endoprosthesis explantation under combined anesthesia was carried out (CSEA: rachianesthesia at the level of L2-3 associated with the placement of an epidural catheter T7-8) in an aware patient. Surgical access was laparotomic trasverse and exclusion of the aneurysm was done through an aorto-aortic bypass in Dacron prothesis. The patient supported the CSEA well and pain was absent both during the operation and in the postoperative phase. He did not develop respiratory complications neither morbidities-mortalities. At 6-12-18 months from discharge, at the follow-up examination, the patient is in good general health and surgical results were good. The authors have used the same anesthetic technique to treat seven other patients with AAA and severe COPD, unsuitable for exclusion of the AAA through EVAR, with analogous results. Even though it is impossible to draw statistically relevant conclusions or carry out comparisons with other techniques, it can be asserted that the surgical method of repair is effective, without complications and without morbid-mortalities. Furthermore, the authors believe that the surgical reconstruction of AAA using combined anesthesia in aware patients is a valid alternative treatment for those subjects with a high operative risk (severe COPD), untreatable either by open repair surgery of AAA, under general anesthesia, or by EVAR.