title: [Anesthetic considerations for endovascular aortic repair (EVAR)].
abstract: The endovascular repair of thoracic aortic aneurysm and abdominal aortic aneurysm has become a promising alternative for open surgical graft replacement. The benefits of EVAR include less invasiveness, no need for cardiopulmonary bypass or differential lung ventilation, less blood loss, shorter hospital stay and reduced perioperative morbidity and mortality. Therefore EVAR is especially desirable for patients with impaired cardiopulmonary function or multiple comorbidities and they are at high risk of complications following general anesthesia such as stroke, myocardial infarction, acute renal insufficiency, infection and failure to wean from ventilator. Thoracic endovascular aortic repair (TEVAR) also carries the risk of paraplegia induced by spinal cord ischemia. Previous abdominal aortic aneurysm repair, prolonged hypotension, severe atherosclerosis of the thoracic aorta, injury to the external iliac artery, and more extensive coverage of the thoracic aorta by the graft are reported to be the risk factors for paraplegia after TEVAR. In such cases, strategies to protect the spinal cord from ischemia including lumbar cerebrospinal fluid drainage should be taken.
authors.affiliation: Department of Anesthesiology, University of Tokyo Hospital, Tokyo 113-8655.
authors.forename: Jun
authors.initials: J
authors.lastname: Ninagawa
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Kin
mesh_terms: D000758:Anesthesia / Q000379:methods*; D001014:Aortic Aneurysm / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D013116:Spinal Cord / Q000098:blood supply; D015607:Stents