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S5 - Principles III - Test 3 > Endovascular Anesthesia > Flashcards

Endovascular Anesthesia Flashcards

1
Q

When can EVAR be used?

A
  • As an alternative to a conventional open repair
  • Alternative treatment for ruptured AAA
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2
Q

Anesthetic options for EVAR

A
  • General
  • Regional
  • MAC with local anesthesia
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3
Q

Comparison of mortality for open repair vs EVAR

A

Basically short term mortality is significantly lower but long term survival is similar

Long term looked at because how they secure the graft in EVAR is a little less secure than in the open repair

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4
Q

Benefits of EVAR

A
  • Reduced blood loss
  • Reduced length of ICU and hospital stay
  • Increased patients discharged home (aka didnt die)
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5
Q

Patient criteria for EVAR

A
  • Femoral artery w/o significant disease or occlusion
    • At least 8 mm in diameter without extreme tortusity
    • Alternative: if Iliac artery also meets criteria from graft manufacturer
  • Renal arteries > 1.5 cm from top of aneurysm
  • Aortic bifurcation >1 cm away from distal end of aneurysm
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6
Q

Which is the most commonly used access site for EVAR?

alternative?

A

Femoral (80%)

Iliac (20%)

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7
Q

What all needs to be prepped in EVAR?

A

Both groins and entire abdomen

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8
Q

When and what level of heparinization required for EVAR?

why?

A

Anticoagulation maintained throughout procedure until cutdown is repaired and distal pulses verified

Heparinization with ACT >300 seconds

Balloon causes stagnant blood flow just like the cross clamp does in open

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9
Q

How is the abdominal aorta accessed in EVAR?

A
  • most commonly femoral artery
  • 12 French sheath inserted
  • Guidewire is used to access abodminal aorta
  • Under fluoro, stent is threaded
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10
Q

What to watch for when threading stent in abdominal aorta in EVAR?

A

Arrhythmias

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11
Q

How is the graft attached to the vessel in EVAR?

A

Inflatable balloon catheter is placed inside the proximal portion of the stent/graft which is the attachment system

Inflate balloon for 30-60 seconds to expand stent and attach it via hooks embedding into the normal arterial wall

Some systems are self deploying and dont require a balloon

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12
Q

What should BP be when stent is deployed in EVAR?

A

Reduced to 100 mm Hg

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13
Q

How to assess accuracy of stent placement in EVAR

A

Ultrasound

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14
Q

vessel related complications of endovascular repairs

A

Dissection or rupture of aorta

Ischemia distal to iliofemoral arteriotomy

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15
Q

What other complications can occur from EVAR besides injury to vessels?

A
  • Embolization of plaque to distal vessel
  • Reaction to radiographic contrast
  • Displacement of stent/graft to occlude renal or mesenteric arteries (aortic) or subclavian (thoracic)
  • Endoleak
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16
Q

What is endoleak?

Causes?

A

Persistance of blood flow outside the graft and aneurysmic vessel wall

Causes:

  • Can be due to misplacement or poor sizing
  • Device failure or fatigue
  • Reaction between sac and graft
17
Q

What type of endoleak is caused by flow through porous graft material?

A

Type IV

18
Q

What type of endoleak is caused by retrograde flow into sac from a collateral vessel?

A

Type II

19
Q

What type of endoleak is caused by tear or defect in graft or leak between two segments?

A

Type III

20
Q

What type of endoleak is caused by inadequate seal at either proximal or distal?

A

Type I

21
Q

Goals of Anesthetic for EVAR

(Basically the same goals we have for every other anesthetic)

A
  • Maintain HD stability
  • Oxygenation and ventilation - prevent respiratory depression
  • Preserve organ function
  • Maintain normothermia
  • May be general, regional, or local
22
Q

Challenges related to EVAR

A
  • Patient must be perfectly still
    • Fluoroscopy required positioning of stent
  • Hemodynamic challenges
  • Nephropathy related to radiographic contrast
    • Well hydrate intraop and postop
23
Q

Hemodynamic challenges related to EVAR

A
  • Avoid tachycardia and hypertension
  • MAP at 60 mm Hg during balloon inflation
  • Vasopressors and inotropes available
24
Q

Potential bleeding complications for EVAR

A
  • Potential for hemorrhage and conversion to open procedure
  • Blood loss may be hidden- around sheaths, retroperitoneal
    • Check Hgb if patient becomes unstable
25
Q

Compare anesthetic techniques for EVAR in study where 92% used regional, 4% under general, and 4% local?

A
  • No difference in length of surgery or in-hospital stay
  • Length of hospital stay was longer with GA than with RA and LA
  • Lower fluid requirements and less need for vasopressors with LA
  • Avoid GA with pulmonary comorbidities
26
Q

Compare anesthetic techiniques for intrarenal EVAR

A

No difference in morbidity and mortality rates when GA compared with RA and LA

S5 - Principles III - Test 3 (3 decks)

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