Regional Anesthesia for Endovascular Treatment of Abdominal Aortic Aneurysms

Aadahl, Petter; Lundbom, Jan; Hatlinghus, Staal; Myhre, Hans O.

doi:10.1177/152660289700400110

Cited by 13 publications

(16 citation statements)

References 14 publications

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“…Emergency operation for aortic rupture or acute dissection is associated with a higher risk of early death after operation compared with elective operation (47 Choice of anesthetic technique is dependent on the planned surgical interventions and the patient's comorbid conditions. For placement of endovascular aortic stent grafts, different anesthetic (local, regional, general) techniques have been described, although adequate comparative studies are lacking (637)(638)(639)(640)(641)(642)(643). Percutaneous placement of catheters with a limited incision may be tolerated with local anesthesia and sedation.…”

Section: Preoperative Risk Assessmentmentioning

confidence: 99%

“…Retrospective studies indicate that patients having local versus regional or general anesthesia for endovascular stent grafts tend to have lower use of vasoactive agents and lower fluid requirements, shorter intensive care and hospital stays (642), earlier ambulation and gastrointestinal function (637), and lower incidence of respiratory and renal complications (643). In a large multicenter retrospective study of 5557 patients undergoing endovascular aortic repairs (644), 69% received general anesthesia, 25% received regional anesthesia, and 6% received local anesthesia.…”

Section: Preoperative Risk Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

Hiratzka¹,

Bakris²,

Beckman³

et al. 2010

Journal of the American College of Cardiology

1,308

396

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Section: Preoperative Risk Assessmentmentioning

confidence: 99%

Section: Preoperative Risk Assessmentmentioning

confidence: 99%

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

Hiratzka¹,

Bakris²,

Beckman³

et al. 2010

Journal of the American College of Cardiology

1,308

396

View full text Add to dashboard Cite

“…[34][35][36][37][38] This change is especially true as individual centers gain experience, shorten their operating time, and evolve from the early learning and investigational nature of the procedure. Thus, some centers are using spinal, epidural, and even monitored anesthesia care.…”

Section: Continued Controversymentioning

confidence: 97%

Endovascular Abdominal Aortic Aneurysm Repair

Kuchta

2003

Semin Cardiothorac Vasc Anesth

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Although endovascular surgery for aortic aneurysms can be traced to the 19th century, open surgery has dominated during the past 50 years. Indeed, open repair of aneurysms has been one of the most successful developments in vascular surgery. Despite improvements in mortality rates, open repair remains a major operation often undertaken in patients with significant comorbidities. Starting from basic research dating back several decades, the 1990s were noted for very active clinical development of endovascular abdominal aortic repair in an attempt to provide an alternative to open repair, especially for high-risk patients. Early successes with decreased intensive care unit and hospital stays were tempered by technical issues and the "endoleak," the term given to an incomplete exclusion of the aneurysm from the circulation. This potential for rupture, despite treatment, was cause for concern. The need for long-term surveillance and secondary procedures, if not conversion to open repair, further compounded these issues. Despite these concerns, progress continued, and by the end of 2002, the Food and Drug Administration had approved three devices for marketing. Although surgeons are faced with increasingly complex issues related to endovascular repair, anesthesiologists have found their management of this procedure to be simpler in many ways. The smaller incisions and improved hemodynamic stability have led to a variety of anesthetics being tried, including monitored anesthesia care. Anesthesiologists continue to explore a number of opportunities to improve patient outcome in these procedures. These include selection of the most optimal anesthetic, the most appropriate perioperative renal protection, and the best preparation for and management of a conversion to an open procedure. Whatever the final role for endovascular surgery in the management of abdominal aortic aneurysms, it is an intellectually stimulating and scientifically promising technique for surgeons, anesthesiologists, and the patients they serve.A lthough it is common to trace endovascular A aortic surgery to the clinical trials of the 1990s, which were based on experimental work dating from 1969,1,2 endovascular techniques can

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“…27,32 The initial dose of spinal local anesthetic may become inadequate during a long repair. Since the epidural catheter is not fully tested on initial placement, the risk of conversion to general anesthesia may be increased.…”

Section: Regional Anesthesiamentioning

confidence: 99%

Endovascular Repair of the Abdominal Aortic Aneurysm

Santamore¹,

Saldanha

Santamore

2003

Semin Cardiothorac Vasc Anesth

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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

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Regional Anesthesia for Endovascular Treatment of Abdominal Aortic Aneurysms

Cited by 13 publications

References 14 publications

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

Endovascular Abdominal Aortic Aneurysm Repair

Endovascular Repair of the Abdominal Aortic Aneurysm

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