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Anesthetic Considerations for Complex Endovascular Aortic Repair

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Endovascular Aortic Repair

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Abstract

Endovascular therapy for aortic pathology continues to open new frontiers in managing aortic pathology. Anesthesiology and perioperative medicine has had to evolve accordingly to care for this complex patient population. This chapter focuses on anesthetic and perioperative care considerations for complex endovascular aortic repair. The importance of a thorough preoperative evaluation and open discussion of the procedural plan is emphasized. Depending on the complexity of the procedure, anesthesia technique may differ. Key considerations include specific hemodynamic and neurologic monitoring, appropriate spinal cord protection, and techniques to induce temporary hypotension to facilitate more proximal aortic graft deployments.

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References

  1. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365(9478):2179–2186.

    Google Scholar 

  2. Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607–18.

    Article  CAS  PubMed  Google Scholar 

  3. Chang DC, Parina RP, Wilson SE. Survival after endovascular vs open aortic aneurysm repairs. JAMA Surg. 2015;2:1–7.

    Google Scholar 

  4. De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, 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 

  5. Oderich GS, Mendes BC, Gloviczki P, Kalra M, Duncan AA, Bower TC. Current role and future directions of hybrid repair of thoracoabdominal aortic aneurysms. Perspect Vasc Surg Endovasc Ther. 2012;24(1):14–22.

    PubMed  Google Scholar 

  6. Oderich GS, Correa MP, Mendes BC. Technical aspects of repair of juxtarenal abdominal aortic aneurysms using the Zenith fenestrated endovascular stent graft. J Vasc Surg. 2014;59(5):1456–61.

    Article  PubMed  Google Scholar 

  7. de Souza LR, Oderich GS, Banga PV, Hofer JM, Wigham JR, Cha S, et al. Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts. J Vasc Surg. 2015;62(6):1442–9.

    Article  PubMed  Google Scholar 

  8. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64(22):e77–137.

    Article  PubMed  Google Scholar 

  9. Zhan HT, Purcell ST, Bush RL. Preoperative optimization of the vascular surgery patient. Vasc Health Risk Manag. 2015;11:379–85.

    PubMed  PubMed Central  Google Scholar 

  10. Bertges DJ, Goodney PP, Zhao Y, Schanzer A, Nolan BW, Likosky DS, et al. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients. J Vasc Surg. 2010;52(3):674-683, 683 e671-683 e673.

    Google Scholar 

  11. Sloan TB, Edmonds Jr HL, Koht A. Intraoperative electrophysiologic monitoring in aortic surgery. J Cardiothorac Vasc Anesth. 2013;27(6):1364–73.

    Article  PubMed  Google Scholar 

  12. Keyhani K, Miller 3rd CC, Estrera AL, Wegryn T, Sheinbaum R, Safi HJ. Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49(1):36–41.

    Article  PubMed  Google Scholar 

  13. Etz CD, Weigang E, Hartert M, Lonn L, Mestres CA, Di Bartolomeo R, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Eur J Cardiothorac Surg. 2015;47(6):943–57.

    Article  PubMed  Google Scholar 

  14. Estrera AL, Sheinbaum R, Miller CC, Azizzadeh A, Walkes JC, Lee TY, et al. Cerebrospinal fluid drainage during thoracic aortic repair: safety and current management. Ann Thorac Surg. 2009;88(1):9–15. discussion 15.

    Article  PubMed  Google Scholar 

  15. Cheung AT, Pochettino A, McGarvey ML, Appoo JJ, Fairman RM, Carpenter JP, et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg. 2005;80(4):1280–8. Discussion 1288–1289.

    Article  PubMed  Google Scholar 

  16. Wynn MM, Mell MW, Tefera G, Hoch JR, Acher CW. Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. J Vasc Surg. 2009;49(1):29–34. Discussion 34–25.

    Article  PubMed  Google Scholar 

  17. Weaver KD, Wiseman DB, Farber M, Ewend MG, Marston W, Keagy BA. Complications of lumbar drainage after thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2001;34(4):623–7.

    Article  CAS  PubMed  Google Scholar 

  18. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (third edition). Reg Anesth Pain Med. 2010;35(1):64–101.

    Article  CAS  PubMed  Google Scholar 

  19. Fedorow CA, Moon MC, Mutch WA, Grocott HP. Lumbar cerebrospinal fluid drainage for thoracoabdominal aortic surgery: rationale and practical considerations for management. Anesth Analg. 2010;111(1):46–58.

    PubMed  Google Scholar 

  20. Weisbord SD, Palevsky PM. Prevention of contrast-induced nephropathy with volume expansion. Clin J Am Soc Nephrol. 2008;3(1):273–80.

    Article  CAS  PubMed  Google Scholar 

  21. Sterling KA, Tehrani T, Rudnick MR. Clinical significance and preventive strategies for contrast-induced nephropathy. Curr Opin Nephrol Hypertens. 2008;17(6):616–23.

    Article  PubMed  Google Scholar 

  22. Greenberg RK, Lu Q, Roselli EE, Svensson LG, Moon MC, Hernandez AV, et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation. 2008;118(8):808–17.

    Article  PubMed  Google Scholar 

  23. Czerny M, Eggebrecht H, Sodeck G, Verzini F, Cao P, Maritati G, et al. Mechanisms of symptomatic spinal cord ischemia after TEVAR: insights from the European Registry of Endovascular Aortic Repair Complications (EuREC). J Endovasc Ther. 2012;19(1):37–43.

    Article  PubMed  Google Scholar 

  24. Jacobs MJ, Elenbaas TW, Schurink GW, Mess WH, Mochtar B. Assessment of spinal cord integrity during thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2002;74(5):S1864–1866. Discussion S1892–1868.

    Article  PubMed  Google Scholar 

  25. Mutch WA. Control of outflow pressure provides spinal cord protection during resection of descending thoracic aortic aneurysms. J Neurosurg Anesthesiol. 1995;7(2):133–8.

    Article  CAS  PubMed  Google Scholar 

  26. Augoustides JG, Stone ME, Drenger B. Novel approaches to spinal cord protection during thoracoabdominal aortic interventions. Curr Opin Anaesthesiol. 2014;27(1):98–105.

    Article  PubMed  Google Scholar 

  27. Etz CD, Zoli S, Bischoff MS, Bodian C, Di Luozzo G, Griepp RB. Measuring the collateral network pressure to minimize paraplegia risk in thoracoabdominal aneurysm resection. J Thorac Cardiovasc Surg. 2010;140(6 Suppl):S125–130. Discussion S142–S146.

    Article  PubMed  Google Scholar 

  28. Muzevich KM, Voils SA. Role of vasopressor administration in patients with acute neurologic injury. Neurocrit Care. 2009;11(1):112–9.

    Article  PubMed  Google Scholar 

  29. Obritsch MD, Bestul DJ, Jung R, Fish DN, MacLaren R. The role of vasopressin in vasodilatory septic shock. Pharmacotherapy. 2004;24(8):1050–63.

    Article  CAS  PubMed  Google Scholar 

  30. Ricotta 2nd JJ, Harbuzariu C, Pulido JN, Kalra M, Oderich G, Gloviczki P, et al. A novel approach using pulmonary artery catheter-directed rapid right ventricular pacing to facilitate precise deployment of endografts in the thoracic aorta. J Vasc Surg. 2012;55(4):1196–201.

    Article  PubMed  Google Scholar 

  31. Nienaber CA, Kische S, Rehders TC, Schneider H, Chatterjee T, Bünger CM, et al. Rapid pacing for better placing: comparison of techniques for precise deployment of endografts in the thoracic aorta. J Endovasc Ther. 2007;14(4):506–12.

    Article  PubMed  Google Scholar 

  32. Chen J, Huang W, Luo S, Yang D, Xu Z, Luo J. Application of rapid artificial cardiac pacing in thoracic endovascular aortic repair in aged patients. Clin Interv Aging. 2014;9:73–8.

    PubMed  Google Scholar 

  33. Lee WA, Martin TD, Gravenstein N. Partial right atrial inflow occlusion for controlled systemic hypotension during thoracic endovascular aortic repair. J Vasc Surg. 2008;48(2):494–8.

    Article  PubMed  Google Scholar 

  34. Cires G, Noll Jr RE, Albuquerque Jr FC, Tonnessen BH, Sternbergh 3rd WC. Endovascular debranching of the aortic arch during thoracic endograft repair. J Vasc Surg. 2011;53(6):1485–91.

    Article  PubMed  Google Scholar 

  35. Nicolaou G, Forbes TL. Strategies for accurate endograft placement in the proximal thoracic aorta. Semin Cardiothorac Vasc Anesth. 2010;14(3):196–200.

    Article  PubMed  Google Scholar 

  36. Bell D, Bassin L, Neale M, Brady P. A review of the endovascular management of thoracic aortic pathology. Heart Lung Circ. 2015;24(12):1211–5.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Divisions of Cardiovascular Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Juan N. Pulido

  2. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

    Erica D. Wittwer

  3. Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Aaron C. Baker

  4. Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Gustavo S. Oderich

Authors
  1. Juan N. Pulido
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  2. Erica D. Wittwer
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  3. Aaron C. Baker
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  4. Gustavo S. Oderich
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Corresponding author

Correspondence to Gustavo S. Oderich .

Editor information

Editors and Affiliations

  1. Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA

    Gustavo S. Oderich

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© 2017 Mayo Foundation for Medical Education and Research

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Pulido, J.N., Wittwer, E.D., Baker, A.C., Oderich, G.S. (2017). Anesthetic Considerations for Complex Endovascular Aortic Repair. In: Oderich, G. (eds) Endovascular Aortic Repair. Springer, Cham. https://doi.org/10.1007/978-3-319-15192-2_22

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  • DOI: https://doi.org/10.1007/978-3-319-15192-2_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15191-5

  • Online ISBN: 978-3-319-15192-2

  • eBook Packages: MedicineMedicine (R0)

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