Anaesthesia for Endovascular Aortic Aneurysm Repair (EVAR)

Abstract

An aortic aneurysm is a localized dilatation greater than 50% of the original diameter. The normal size of the aorta is 2 cm; thus, an aneurysmal enlargement of three or more centimeters is an abnormal finding. Aneurysms occur in both the abdominal and thoracic cavities and are defined by their location. Approximately 80% of aortic aneurysms occur between the renal arteries and the aortic bifurcation (Aggarwal et al., Exp Clin Cardiol. 16:11–5, 2011). While they can be repaired by open surgical approach, minimally invasive endovascular approach has become the preferred surgical option in patients with suitable aortic anatomy. In the United States in 2010, approximately 78% of non-ruptured aneurysms were repaired by EVAR (Dua et al., J Vasc Surg. 59:1512–7, 2014). The rapid adaptation of vascular surgeons to endovascular techniques, as well as the advent of branched-fenestrated grafts, has notably increased the number of patients who undergo non-open aortic aneurysm repair. This chapter specifically focuses on the pre-operative evaluation, anesthetic management, and post-operative care of patients undergoing abdominal and thoracic endovascular aortic aneurysm repair.