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Chirurgia 2019 August;32(4):155-9

DOI: 10.23736/S0394-9508.18.04804-0


language: English

Percutaneous and surgical femoral access for thoracic endovascular aortic repair using local anesthesia

Raffaele SERRA 1, 2 , Antonio DI VIRGILIO 3, Davide TURCHINO 2, Nicola IELAPI 1, Stefano DE FRANCISCIS 1, 2, Ciro INDOLFI 2, Pasquale MASTROROBERTO 3

1 Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Magna Græcia University, Catanzaro, Italy; 2 Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy; 3 Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy

BACKGROUND: Nowadays, thoracic endovascular aortic repair (TEVAR) is frequently the choice for treatment of thoracic aortic disease because of its less invasiveness. Generally, this technique is performed with surgical femoral access with general and epidural anesthesia or with a local anesthesia without spinal catheterization, but there is evidence in literature that suggests the validity of percutaneous approach. The aim of this study is to compare the different techniques according to our personal experience.
METHODS: We retrospectively studied patients affected from thoracic aortic disease, in particular those with thoracic aortic aneurysm (TAA) and acute type B aortic dissection (TBAD), in the period September 2002 to December 2016. The first endpoint was the possibility to achieve the femoral access only by local anesthetic injection, and the second endpoint was the comparison between TEVAR with femoral exposure and the percutaneous approach.
RESULTS: From September 2002 to December 2016 we have selected a cohort of 45 patients affected by thoracic aortic disease, divided in 22 patients with thoracic aortic aneurism (TAA) and 23 patients with acute type B aortic dissection (TBAD). All patients were treated with TEVAR undergoing a local anesthesia. Most of the patients were treated with surgical exposition of the common femoral artery while in 10 eligible patients was used the percutaneous approach. In all cases we had correct placement of the endograft, exclusion of false lumen in case of TBAD and absence of primary endoleak in case of TAA after the procedure.
CONCLUSIONS: The use of the local anesthesia, and of the percutaneous approach when possible, have proven to be particularly effective in our casuistry.

KEY WORDS: Endovascular procedures - Thoracic aorta - Thoracic aortic aneurysm

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