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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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III. MANAGEMENT OF THE “POLYVASCULAR PATIENT”
2. ABDOMINAL AORTIC ANEURYSMS AND CONCOMITANT CORONARY DISEASE
B. Endovascular repair  THE MULTIFOCAL ATHEROSCLEROTIC PATIENT
DIAGNOSIS AND MANAGEMENT IN 2003


The Journal of Cardiovascular Surgery 2003 June;44(3):443-51

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Anesthesia for endovascular repair of abdominal and thoracic aortic aneurysms

Lippmann M. 1, Lingam K. 1, Rubin S. 1, Julka I. 1, White R. 2

1 Depart­ment of Anes­the­sio­logy, Divi­sion of Vas­cular Sur­gery, Harbor-­UCLA Med­ical ­Center, Tor­rance, CA, USA,
2 Depart­ment of Sur­gery, Divi­sion of Vas­cular Sur­gery, Harbor-­UCLA Med­ical ­Center, Tor­rance, CA, USA


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­Open ­repair of abdom­inal ­aortic aneu­rysms (AAA) and tho­racic ­aortic aneu­rysms (TAA) are asso­ciated ­with sig­nif­i­cant mor­bidity and mor­tality. Endo­vas­cular ­aortic aneu­rysm ­repair (­EVAAR) ­using a ­stent ­graft is a new alter­na­tive to tra­di­tional ­open ­repair. ­There are var­ious ­types of anes­thesia ­which can be uti­lized for ­EVAAR; spe­cif­i­cally gen­eral endo­tra­cheal anes­thesia, reg­ional anes­thesia, and mon­i­tored anes­thesia ­care (MAC) ­with ­local anes­thetic infil­trated at the inci­sion ­site. ­Choice of anes­thetic tech­nique may be depen­dent ­upon a ­patient’s co-­existing dis­eases. We ­have pre­pared a ­review ­article dis­cussing the var­ious ­types of anes­thesia avail­able for ­this pro­ce­dure, ­including the spe­cifics of ­each tech­nique and ­pros and ­cons of ­each ­option. The ­most ­often uti­lized tech­nique ­appears to be gen­eral anes­thesia, ­often ­times ­related to sur­geon unfa­mil­iarity ­with the ­EVAAR pro­ce­dure. ­Regional tech­niques, ­including con­tin­uous epi­dural or con­tin­uous ­spinal anes­thesia are uti­lized in ­some ­cases ­with ­very ­good ­results. ­This tech­nique can pro­vide ­more hemo­dy­namic ­stability and ­better ­pain con­trol ­than gen­eral alter­na­tive, MAC ­with ­local, is an ­extremely ­safe and effec­tive tech­nique for the ­EVAAR pro­ce­dure, espe­cially in ­patients ­with ­severe co-­existing dis­eases. In addi­tion, ­this tech­nique ­also min­i­malizes seda­tion and ­post-oper­a­tive anal­gesic require­ments, ­decreases car­di­o­pul­mo­nary com­pli­ca­tions, and ­decreases ­overall hos­pital ­stay, ­thereby ­reducing ­cost.

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