Transfemoral endografting of thoracic aortic aneurysm under local anesthesia: a simple, safe and fast track procedure.
BACKGROUND
Endovascular aneurysm grafting of the descending thoracic aorta is a minimally invasive catheter technique, which is performed under general anesthesia. We describe a technique allowing to perform transfemoral endovascular repair of thoracic aortic repair under local anesthesia.


METHODS
In 9 consecutive patients local anesthesia was performed in order to gain an opened femoral artery access for the delivery system, and a percutaneous access to the left brachial artery. A pigtail catheter was then placed through the left brachial artery for the location of the origin of the left subclavian artery and/or the aneurysm and self-expanding endoprosthesis was released under fluoroscopic guidance. For the deployment of the endograft a short period of controlled hypotension with nitroglycerin bolus application was produced.


RESULTS
All the aneurysms could be successfully sealed with the intended endovascular technique. There was no vascular access complication or pulmonary or ischemic (cardiac, cerebral or peripheral) complication. In the follow-up period of 6 +/- 3 months one patient needed a redo endovascular procedure because of the development of a severe and symptomatic distal endoleak 6 weeks postoperative. This procedure was again performed under local anesthesia.


CONCLUSIONS
From a technical point of view, transfemoral endovascular repair of thoracic aneurysm can be performed under local anesthesia. This is a very simple and fast track procedure which combines a minimally invasive catheter technique and a less invasive anesthetic management.
Lachat
M
M
Department of Cardiovascular Surgery, University Hospital Zurich, Switzerland. Lachat@chi.usz.ch
Pfammatter
T
T
Turina
M
M
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D016896:Treatment Outcome