Retrospective Review of 100 Cases of Endoluminal Aortic Stent-Graft Surgery from an Anaesthetic Perspective

Abstract

One hundred cases of endoluminal aortic stent surgery were retrospectively reviewed and analysed with respect to outcome. The overall mortality rate was consistent with standard rates for open surgical repair. One hundred per cent of patients who developed multiorgan failure died (7), as did 78% of those who developed acute renal failure (9), and 55% of those who had a serum creatinine rise greater than 100 µmol/l (9). Patients given mannitol had an increased incidence of a serum creatinine rise of greater than 100 µmol/l, at 16% versus 4% for those not given mannitol. Patients with documented intra-or postoperative anaemia (Hb <80 g/l) had a mortality rate of 22% compared to 5% for non-anaemic patients. The mortality rate increased from 3% to 15% if the procedure took more than four hours. The anaesthetic requirements for this new type of surgery are outlined and discussed with respect to these results. The surgical technique is summarized.

Neutrophil Respiratory Burst Activity and Pro- and Anti-inflammatory Cytokines in AAA Surgery: Conventional versus Endoluminal Treatment

“…Moreover, local anesthesia contributes to reduced length of hospitalization. 20,21 In addition, all patients received mannitol, which functions as a scavenger to attenuate the ischemic reperfusion response, which could have affected neutrophil activity. In vitro, mannitol decreases reactive oxygen metabolites and the respiratory burst of neutrophils, thus contributing to the attenuation of this function in all patients.…”

Endovascular Repair of the Abdominal Aortic Aneurysm

“…16 Rupture or dissection of the aneurysm warrants an emergent laparotomy. 16 If the graft inadvertently twists or rotates after the proximal stent is in place, or balloon malfunction occurs, open correction is required.12 If the renal or mesenteric arteries are occluded with a misplaced proximal stent, open correction is warranted. 16 Complications Despite its minimally invasive appeal, several significant complications are associated with endovascular AAA repair (see Table 1.)…”

“…16 If the graft inadvertently twists or rotates after the proximal stent is in place, or balloon malfunction occurs, open correction is required.12 If the renal or mesenteric arteries are occluded with a misplaced proximal stent, open correction is warranted. 16 Complications Despite its minimally invasive appeal, several significant complications are associated with endovascular AAA repair (see Table 1.) Acute rupture of the aorta appears more likely to occur during stent graft deployment, but it can occur at any time during endovascular AAA repair.…”

“…Acute rupture of the aorta appears more likely to occur during stent graft deployment, but it can occur at any time during endovascular AAA repair. 15,16,27 The results are of course disastrous, with sudden and massive blood loss. In the event of an acute rupture, the movable balloon catheter can be repositioned and inflated proximal to the presumed site of aortic rupture.…”

“…11 The other major Food and Drug Administrationapproved device is the AneuRx graft (Medtronic Corporation, Minneapolis, Minnesota).15 Depending on the anatomy of the AAA, the endovascular grafting options include a simple tube stent, or a more complex bifurcated or aorto-uni-iliac endograft, or the segmented bifurcated stent graft.2'6'15 From Parodi's first surgery in 1991, nearly 10,000 similar procedures have been performed worldwide. 15 Surgical Technique Infrarenal endovascular aortic aneurysm repair is usually performed through a femoral arteriotomy.11"12'16 If the femoral artery is too tortuous, the iliac artery provides another suitable entry point.14 As these devices are further developed, percutaneous access may become an option.17 Accumulation of arthrosclerotic plaque in the iliac artery that prevents sheath insertion prohibits an endovascular repair.12 '14 After heparin administration and placement of vascular clamps distal to the arteriotomy, the intraluminal prosthesis is advanced over a guide wire into the abdominal aorta.1, 16 The system is positioned correctly by repeated use of fluoroscopy and intra-arterial radio-opaque contrast dye. '4'16 With this radiographic guidance, the device is positioned such that it lies above and below the aortic aneurysm.3 The proximal attachment system is positioned just below the renal arteries.…”