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Anesthesia for Open AAA

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Abstract

Abdominal aortic aneurysms (AAA) affect approximately 9% of men and 2% of women, with a strong predilection in adults >65 years old and smokers. The mortality of ruptured AAA approaches 90% and it is the 15th leading cause of death in adults 60 years and older. Endovascular aneurysm repair has quickly replaced open repair for infra-renal AAA, accounting for over 80% of all AAA repairs in the US. Compared to endovascular treatment options, open repair remains the definitive treatment, with proven long-term risk reduction of aneurysm rupture. Careful preoperative optimization is required to reduce perioperative morbidity and mortality. Special attention is given to pre-existing cardiovascular, renal, pulmonary, and neurologic co-morbidities. Invasive cardiovascular monitoring and large bore intravenous access are required in anticipation of rapid hemodynamic shifts during the critical stages of aortic clamping and unclamping.

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References

  1. Bobadilla JL, Kent KC. Screening for abdominal aortic aneurysms. Adv Surg. 2012;46:101–9.

    Article  PubMed  Google Scholar 

  2. Guirguis JM, Beil TL, Sun X, Senger CA, Whitlock EP. Primary care screening for abdominal aortic aneurysm: an evidence update for the U.S. Preventive Services Task Force. Rockville; 2014.

    Google Scholar 

  3. Lindholt J, Ashton H, Heickendorff L, Scott R. Serum elastin peptides in the preoperative evaluation of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2001;22(6):546–50.

    Article  CAS  PubMed  Google Scholar 

  4. Dale M, Xiong W, Carson J, Suh M, Karpisek A, Meisdinger T, et al. Elastin-derived peptides promote abdominal aortic aneurysm formation by modulating M1/M2 macrophage polarization. J Immunol. 2016;196(11):4536–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lederle F, Wilson S, Johnson G, Reinke D, Littooy FN, Acher C, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1437–44.

    Article  PubMed  Google Scholar 

  6. Brewster D, Cronenwett J, Hallett J, Johnston K, Krupski W, Matsumura J. Guidelines for the treatment of abdominal aortic aneurysms. J Vasc Surg. 2003;37(5):1106–17.

    Article  PubMed  Google Scholar 

  7. Hollier L, Taylor L, Ochsner J. Recommended indications for operative treatment of abdominal aortic aneurysms. J Vasc Surg. 1992;15(6):1046–56.

    Article  CAS  PubMed  Google Scholar 

  8. Upchurch G, Schaub T. Abdominal aortic aneurysm. Am Fam Physician. 2006;73(7):1198–204.

    PubMed  Google Scholar 

  9. The United Kingdom EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysms. N Engl J Med. 2010;362(20):1863–71.

    Article  CAS  Google Scholar 

  10. Lederle F, Freischlag J, Kyriakides T, Padberg FJ, Matsumura J, Kohler T, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302(14):1535–42.

    Article  CAS  PubMed  Google Scholar 

  11. De Bruin J, Baas A, Buth J, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362(20):1881–9.

    Article  PubMed  Google Scholar 

  12. Becquemin JP, Pillet JC, Lescalie F, et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg. 2011;53(5):1167–73.

    Article  PubMed  Google Scholar 

  13. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM, et al. Endovascular versus open repair of abdominal aortic aneurysm in 15 years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388:2366–74.

    Article  PubMed  Google Scholar 

  14. IMPROVE Trial Investigators, Braithwaite B, Cheshire N, Greenhalgh R, Grieve R, Hassan T, et al. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial. Eur Heart J. 2015;36(31):2061–9.

    Article  PubMed Central  Google Scholar 

  15. Fleisher L, Fleischmann K, Auerbach A, Barnason S, Beckman J, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. J Am Coll Cardiol. 2014;64(22):e77–e137.

    Article  PubMed  Google Scholar 

  16. POISE Study Group, Devereaux P, Yang H, Yusuf S, Guyatt G, Leslie K, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839–47.

    Article  CAS  Google Scholar 

  17. Flu W, van Kuijk J, Chonchol M, Winkel T, Verhagen H, Bax J, et al. Timing of pre-operative beta-blocker treatment in vascular surgery patients: influence on post-operative outcome. J Am Coll Cardiol. 2010;56(23):1922–9.

    Article  PubMed  Google Scholar 

  18. Kertai M, Boersma E, Westerhourt C, van Domburg R, Klein J, Bax J, et al. Association between long-term statin use and mortality after successful abdominal aortic aneurysm surgery. Am J Med. 2004;116(2):96–103.

    Article  CAS  PubMed  Google Scholar 

  19. Molnar A, Coca S, Devereaux P. Statin use associates with a lower incidence of acute kidney injury after major elective surgery. J Am Soc Nephrol. 2011;22(5):939–46.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Levin G, Bates E, Bittl J, Brindis R, Fihn S, Fleisher L, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. J Am Coll Cardiol. 2016;68(10):1243–75.

    Google Scholar 

  21. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.

    Article  CAS  Google Scholar 

  22. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert J. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144–54.

    Article  PubMed  Google Scholar 

  23. Grønkjær M, Eliasen M, Skov-Ettrup L, Tolstrup J, Christiansen A, Mikkelsen S, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52–71.

    Article  PubMed  Google Scholar 

  24. Axelrod DA, Henke PK, Wakefield TW, et al. Impact of chronic obstructive pulmonary disease on elective and emergency abdominal aortic aneurysm repair. J Vasc Surg. 2001;33:72–6.

    Article  CAS  PubMed  Google Scholar 

  25. Upchurch GR, Proctor MC, Henke PK, et al. Predictors of severe morbidity and death after elective abdominal aortic aneurysmectomy in patients with chronic obstructive pulmonary disease. J Vasc Surg. 2003;37:594–9.

    Article  PubMed  Google Scholar 

  26. van Lier F, van der Geest PJ, Hoeks SE, et al. Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease. Anesthesiology. 2011;115:315–21.

    Article  CAS  PubMed  Google Scholar 

  27. Grant SW, Grayson AD, Purkayastha D, McCollum CN. What are the risk factors for renal failure following open elective abdominal aortic aneurysm repair? Eur J Vasc Endovasc Surg. 2012;43(2):182–7.

    Article  CAS  Google Scholar 

  28. Kopolovic I, Simmonds K, Duggan S, et al. Risk factors and outcomes associated with acute kidney injury following ruptured abdominal aortic aneurysm. BMC Nephrol. 2013;14:99.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Eldrup N, Budtz-Lilly J, Laustsen J, Bibby B, Paaske WP. Long-term incidence of myocardial infarct, stroke, and mortality in patients operated on for abdominal aortic aneurysms. J Vasc Surg. 2012;55(2):311–7.

    Article  PubMed  Google Scholar 

  30. Selim M. Perioperative stroke. N Engl J Med. 2007;356:706–13.

    Article  CAS  PubMed  Google Scholar 

  31. Khan SN, Stansby G. Cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic aneurysm surgery. Cochrane Database Syst Rev. 2012;10:CD003635.

    PubMed  Google Scholar 

  32. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Article  Google Scholar 

  33. O’Sullivan CJ, Hynes N, Mahendran B, et al. Haemoglobin A1c (HbA1C) in non-diabetic and diabetic vascular patients. Is HbA1c an independent risk factor and predictor of adverse outcome? Eur J Vasc Endovasc Surg. 2006;32(2):188–97.

    Article  PubMed  Google Scholar 

  34. Marik P, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8.

    Article  PubMed  Google Scholar 

  35. Madger S. Understanding central venous pressure: not a preload index? Curr Opin Crit Care. 2015;21(5):369–75.

    Article  Google Scholar 

  36. Shantikumar S, Patel S, Handa A. The role of cell salvage autotransfusion in abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg. 2011;42(5):577–84.

    Article  CAS  PubMed  Google Scholar 

  37. Afshari A, Wikkelsø A, Brok J, et al. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev. 2011;16(3):CD007871.

    Google Scholar 

  38. Licker M, Christoph E, Cartier V, Mugnai D, Murith N, Kalangos A, et al. Impact of anesthesia technique on the incidence of major complications after open aortic abdominal surgery: a cohort study. J Clin Anesth. 2013;25(4):296–308.

    Article  CAS  PubMed  Google Scholar 

  39. Ruppert V, Leurs L, Steckmeier B, et al. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg. 2006;44(1):16–21.

    Article  PubMed  Google Scholar 

  40. Guay J, Kopp S. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2016;1:CD005059.

    Google Scholar 

  41. Kurz A, Sessler D, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209–15.

    Article  CAS  PubMed  Google Scholar 

  42. Georgakis P, Paraskevas K, Bessias N, et al. Duration of aortic cross-clamping during elective open abdominal aortic aneurysm repair operations and postoperative cardiac/renal function. Int Angiol. 2010;29(3):244–8.

    PubMed  CAS  Google Scholar 

  43. Ellenberger C, Schweizer A, Diaper J, et al. Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery. Intensive Care Med. 2006;32(11):1808–16.

    Article  PubMed  Google Scholar 

  44. Zacharias M, Mugawar M, Herbison GP, Walker RJ, Hovhannisyan K, Sivalingam P, Conlon NP. Interventions for protecting renal function in the perioperative period. Cochrane Database Syst Rev. 2013;(9). Art. No.: CD003590. https://doi.org/10.1002/14651858.CD003590.pub4.

  45. Park K. Protamine and protamine reactions. Int Anesthesiol Clin. 2004;42(3):135–45.

    Article  PubMed  Google Scholar 

  46. Dorman B, Elliott B, Spinale F, Bailey M, Walton J, Robison J, et al. Protamine use during peripheral vascular surgery: a prospective randomized trial. J Vasc Surg. 1995;22(3):248–55.

    Article  CAS  PubMed  Google Scholar 

  47. Van Damme H, Creemers E, Limet R. Ischaemic colitis following aortoiliac surgery. Acta Chir Belg. 2000;100(1):21.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA

    Jimmy C. Yao M.D.

  2. Department of Anesthesiology, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA

    Milad Sharifpour M.D., M.S.

Authors
  1. Jimmy C. Yao M.D.
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  2. Milad Sharifpour M.D., M.S.
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Corresponding author

Correspondence to Milad Sharifpour M.D., M.S. .

Editor information

Editors and Affiliations

  1. Hospital University Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA

    Basavana G. Goudra

  2. Department of Anesthesiology, Emory University, Atlanta, Georgia, USA

    Michael Duggan

  3. Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Vidya Chidambaran

  4. University Hospitals Birmingham, Birmingham, United Kingdom

    Hari Prasad Krovvidi Venkata

  5. Emory University Hospital, Atlanta, Georgia, USA

    Elizabeth Duggan

  6. University of Alabama at Birmingham, Birmingham, Alabama, USA

    Mark Powell

  7. All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

    Preet Mohinder Singh

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Yao, J.C., Sharifpour, M. (2018). Anesthesia for Open AAA. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_64

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  • DOI: https://doi.org/10.1007/978-3-319-74766-8_64

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

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