Endovascular Repair of the Abdominal Aortic Aneurysm

Abstract

Since the early 1 990s, endovascular surgery has provided another treatment option for the management of abdominal aortic aneurysms. Its shorter postoperative recovery time, absence of an abdominal incision, and avoidance of aortic cross-clamping gives endovascular abdominal aortic aneurysm repair its appeal. New vascular grafts are being developed that may expand the number of eligible candidates. This less-invasive form of abdominal aortic aneurysm repair still provides the anesthesiologist with several challenges. The procedure has been performed under general anesthesia, regional anesthesia, and local anesthesia with monitored anesthesia care. The potential benefits of one anesthetic type over another for endovascular abdominal aortic aneurysm repair have not yet been fully explored. Several intraoperative complications, including acute aortic rupture and misdeployment of the stent graft, can necessitate conversion to an open laparotomy. Endovascular repair in the short term compares favorably to open surgical repair with a reduction in morbidity, blood loss, and hospital stay. Still, endovascular abdominal aortic aneurysm repair is a relatively new corrective modality, and long-term controlled trials comparing it with open repair have not yet been reported. As more research into the technique is performed, new strategies for endovascular abdominal aortic aneurysm repair may further increase the options available to patients. Endovascular surgery is rapidly becoming a common treatment modality for vascular disease. Abdominal aortic aneurysms (AAA), once repaired only by an open surgical procedure, can now be treated via this new minimally invasive technique.' Its shorter postoperative recovery time, the absence of an abdominal incision, and the avoidance of aortic cross-clamping gives endovascular AAA repair its appeal.2'3 Newly designed grafts and wider eligibility criteria allow the technique to be applied to an increasing number of patients.4

Anestesia para intervenção cirúrgica endovascular na aorta abdominal

“…Outros parâmetros têm de ser avaliados, como a quantidade de placas ateromatosas no interior do aneurisma e na sua porção distal. A porção distal do aneurisma tem de estar livre de doença para garantir boa perfusão dos membros, minimizando a migração de placas 17,18 . Obedecidos os critérios, o acesso endovascular é feito pelas artérias femorais, dissecadas de um lado e puncionadas por via percutânea do outro lado.…”

“…The femoral arteries should be at least 8-mm wide because the closed stent has a diameter of 7.5 millimeters, and other parameters have been evaluated, such as the amount of atheromatous plaques in the aneurism and in its distal end. The distal end of the aneurism has to be free of disease to guarantee good perfusion of the limbs, minimizing the migration of plaques 17,18 . If those criteria are fulfilled, the endovascular approach is done through the femoral artery, which is dissected in one side and punctured on the other.…”