Anaesthetic implications of endovascular repair of aortocaval fistula

Sharma, M.P.; George, Keri; Gamble, J. A. S.

doi:10.1046/j.1365-2044.2000.01557-5.x

Cited by 5 publications

(5 citation statements)

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“…However, the sudden increase in afterload can also add to the left ventricular strain and failure, especially in patients with ventricular dysfunction. In those patients with high-output cardiac failure who undergo surgery for AVFs, a thermodilution catheter may be useful in the diagnosis and management of intraoperative left ventricular decompensation due to the sudden increase in afterload and in evaluating the effect of the surgical procedure on cardiac output [4,5], as shown in the case presented here. In our patient, arterial blood pressure rose, and CVP and PAP decreased with no signs of worsening of cardiac failure.…”

Section: Discussionmentioning

confidence: 93%

General anesthesia in a patient with Parkes Weber syndrome with high-output cardiac failure due to multiple arteriovenous fistulas complicated by severe aortic regurgitation

Ninagawa

Yamada

2010

J Anesth

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Parkes Weber syndrome is a rare disease characterized by overgrowth of an extremity linked to the presence of an arteriovenous malformation with multiple arteriovenous fistulas (AVFs). We report a patient with Parkes Weber syndrome with high-output cardiac failure due to multiple AVFs complicated by severe aortic regurgitation (AR) who required surgical treatment for AVFs. Division of the left deep femoral artery and banding of the left superficial femoral artery were performed. Such procedures can cause aggravation of AR and left ventricular failure due to the sudden increase in cardiac afterload. Pulmonary artery pressure, mixed venous oxygen saturation and cardiac index monitored by a thermodilution catheter, and a transesophageal echocardiography were useful in evaluating the effect of the surgical procedure and resultant acute increase in cardiac afterload on cardiac output and left ventricular function.

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Section: Discussionmentioning

confidence: 93%

General anesthesia in a patient with Parkes Weber syndrome with high-output cardiac failure due to multiple arteriovenous fistulas complicated by severe aortic regurgitation

Ninagawa

Yamada

2010

J Anesth

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“…ACF is an uncommon late presentation of penetrating injuries to the aorta and vena cava [7]. It rarely closes spontaneously and usually increases gradually in size [8].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of aortocaval fistula repair associated with aortic valve replacement, severe aortic regurgitation, and bacterial endocarditis

et al. 2011

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We report a case of an adult male who had received a gunshot to the abdomen 12 years earlier. He presented with manifestations of high-output congestive heart failure (CHF), aortic regurgitation (AR), and pulmonary septic embolism. Further investigation revealed an aortocaval fistula (ACF). Following endovascular repair of the ACF, we observed an immediate rise in systemic vascular resistance (SVR), decrease in central venous pressure (CVP), increase in regurgitant flow across the aortic valve, and decrease in central mixed venous oxygenation. A combination of vasodilators and vasopressors was used to maintain hemodynamics. Milrinone infusion was necessary after cardiopulmonary bypass to maintain cardiac output. Even though local anesthesia and light sedation were used for ACF closure, the hemodynamics changed dramatically throughout the procedure. ACF closure under local anesthesia and sedation is preferred because the hemodynamics alterations under local anesthesia are less severe. The rise in SVR and regurgitant flow across aortic valve is less dramatic. As a result, hemodynamic management and separation from cardiopulmonary bypass are easier.

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“…The only effective treatment for this disease is operative closure of the fi stula [1] or endovascular repair of the fi stula [9,10]. An aortic cross clamp may normalize vital signs because of a decreased venous return, but also increases the afterload of the heart and may result in excessive hypertension [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…An aortic cross clamp may normalize vital signs because of a decreased venous return, but also increases the afterload of the heart and may result in excessive hypertension [10,11]. In that case, vasodilating drugs should be carefully administered.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a patient with aortocaval fistula

et al. 2009

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Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm (AAA), and patients with an aortocaval fistula show multiple symptoms. We report an 87-year-old man who was diagnosed as having an AAA with aortocaval fistula and who developed refractory hypotension after induction of anesthesia. Following a phenylephrine injection for slight hypotension induced by anesthetic induction, he developed severe hypotension and bradycardia, and his skin became cyanotic. Vasopressor agents had no immediate effect on the hypotension, but blood pressure gradually increased in about 30 min with continuous infusion of dopamine and noradrenaline. Transesophageal echocardiography (TEE) showed right ventricle (RV) hypokinesis and massive tricuspid regurgitation (TR). Central venous pressure (CVP) showed a remarkably high value. After the repair of the aortocaval fistula, the hemodynamics became stable, RV motion was improved, TR was reduced, and CVP became normal. Anesthetic management of the repair of an aortocaval fistula is very difficult. The hemodynamics changed dramatically throughout anesthesia in our patient with this disorder, even though low-dose anesthetics were used. For the successful treatment of this disorder, preparation for the operation is required before the induction of anesthesia, and urgent closure of the fistula is necessary after the induction of anesthesia. TEE is a useful tool for monitoring hemodynamics in such patients.

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Anaesthetic implications of endovascular repair of aortocaval fistula

Cited by 5 publications

References 0 publications

General anesthesia in a patient with Parkes Weber syndrome with high-output cardiac failure due to multiple arteriovenous fistulas complicated by severe aortic regurgitation

General anesthesia in a patient with Parkes Weber syndrome with high-output cardiac failure due to multiple arteriovenous fistulas complicated by severe aortic regurgitation

Anesthetic management of aortocaval fistula repair associated with aortic valve replacement, severe aortic regurgitation, and bacterial endocarditis

Anesthetic management of a patient with aortocaval fistula

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