Surgical and anesthetic considerations for the endovascular treatment of ruptured descending thoracic aortic aneurysms

Hogendoorn, Wouter; Schlösser, Felix J.V.; Muhs, Bart E.; Popescu, Wanda M.

doi:10.1097/aco.0000000000000028

Cited by 20 publications

(20 citation statements)

References 33 publications

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“…14 However, general anaesthesia was used in our series because of the longer operative time, complicated techniques, and requirement of respiratory system control. 16 The rSO 2 was used to alert the clinician to inadequate cerebral flow during ETAAR. Several reports have indicated that decreased cerebral oxygen saturation was associated with insufficient cerebral perfusion in cardiac surgery and carotid endarterectomy.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

et al. 2019

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Objective Endovascular total aortic arch repair (ETAAR) via needle-based in situ fenestration (ISF) is a major challenge for anaesthesiologists because of haemodynamic instability and the risk of cerebral hypoxia. We herein summarise our experience with anaesthetic management of patients who underwent this procedure. Methods Fourteen patients who underwent ETAAR via ISF for arch pathologies involving the major supra-arch branches were included. Regional cerebral oxygen saturation was measured to monitor cerebral perfusion. Partial extracorporeal circulation (EC) support from the right common femoral vein to the right axillary artery was introduced to provide cerebral perfusion. Results During ISF, vessel rupture occurred in three patients and ventricular fibrillation occurred in one patient. The regional cerebral oxygen saturation significantly decreased during the potential risk period for cerebral ischaemia. Establishment of EC effectively prevented cerebral ischaemia. Conclusions During ETAAR, the risks of haemodynamic instability caused by the procedure and vessel rupture during ISF need to be overcome. Partial EC ensured good cerebral protection in our study, and regional cerebral oxygen saturation monitoring may help to reduce the rate of desaturation.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

et al. 2019

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“… 9 Hogendoorn et al explain that paraplegia after TEVAR is associated with non-reimplantation of intercostal arteries, graft coverage of the left subclavian artery, and compromised flow to collateral blood supply of the spinal cord by embolization of debris material dislodged from the aortic wall during catheter manipulation. 10 Additionally, Chiesa et al have reported that in emergency procedures, blood loss and perioperative hypotension are associated with the occurrence of spinal cord ischemia after elective TEVAR. 11 …”

Section: Discussionmentioning

confidence: 99%

“…In case of paraparesis or permanent paraplegia after TEVAR for rDTAA, the recommendations are to maintain mean aortic pressure between 90 and 110 mmHg after stent deployment and cerebrospinal fluid pressure and central venous pressure below 10 mmHg. 10 , 13 …”

Section: Discussionmentioning

confidence: 99%

TEVAR for ruptured descending thoracic aortic aneurysm: case report

et al. 2016

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A ruptured descending thoracic aortic aneurysm (rDTAA) is a life-threatening condition associated with high morbidity and mortality. Endovascular treatment for rDTAA promotes effective aneurysm exclusion with a minimally invasive approach. The authors report a case of a 76-year-old man with hemodynamically unstable 9-cm-diameter rDTAA treated with emergency thoracic endovascular aortic repair (TEVAR).

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“…It is possible to perform TEVAR under either local, regional or general anaesthesia, in contrary to OR where it can be performed only under general anaesthesia. Therefore, patients with advanced cardiopulmonary comorbidities and those who are unfit for OR may potentially be a suitable candidate for TEVAR and thus a life saving procedure can be performed [25] .…”

Section: Open or Endovascular Repair For Rdtaa?mentioning

confidence: 99%

“…The current paraplegia rate following TEVAR is around 2%-6% [28] in contrary to OR that has a 8.7% rate [16] . This rate in TEVAR can go as high as 15% depending on the presence of many cofounding factors such as hypotension, concomitant repair of abdominal aortic aneurysm, long standing aortic disease and renal failure [25,27,28] .…”

Section: Open or Endovascular Repair For Rdtaa?mentioning

confidence: 99%

Ruptured isolated descending thoracic aortic aneurysm: open or endovascular repair?

Harky¹,

Manu²,

Nasiri³

et al. 2018

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Descending thoracic aortic aneurysm management has gained momentum and became a topic of many debates at international levels since the evolution of endovascular repair. Ruptured descending thoracic aortic aneurysm is a clinical emergency which is associated with high mortality and morbidity rates if not managed properly. Prior to thoracic endovascular aortic repair (TEVAR), open repair (OR) was the gold standard management, however since the evolution of TEVAR, this has changed. Several centers have reported many of their experiences and published that TEVAR can provide equal or even better perioperative outcomes when compared to OR, although the evidences can be of only short term and could be biased at different levels at the time of publication. This review article is aimed to examine current literature evidences behind the use of TEVAR vs. OR and the reported comparative clinical outcomes.

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Surgical and anesthetic considerations for the endovascular treatment of ruptured descending thoracic aortic aneurysms

Cited by 20 publications

References 33 publications

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

TEVAR for ruptured descending thoracic aortic aneurysm: case report

Ruptured isolated descending thoracic aortic aneurysm: open or endovascular repair?

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