Anesthesiologist View on Endovascular Aortic Aneurysm Repair; A Single Center Retrospective Study
Yıl 2023,
Cilt: 18 Sayı: 3, 62 - 68, 20.11.2023
Gamze Ertaş
,
Hamiyet Şenol Çakmak
,
Sevda Akdeniz
,
Ebru Polat
,
İlker Hasan Karal
,
Serkan Tulgar
Öz
Objective: Endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), which are minimally invasive endovascular stent grafting methods, are applied as alternatives to traditional and invasive open surgery in the treatment of aortic aneurysms. The aim of this study was to evaluate the anesthesia methods applied in patients who underwent EVAR and TEVAR in our hospital.
Materials and Methods: The files of 95 patients who underwent endovascular aortic repair between 01.01.2015 and 31.05.2022 were reviewed retrospectively. Descriptive data on patients, as well as data such as the duration of surgery, intensive care and hospital stay were collected and evaluated.
Results: It was determined that endovascular aortic grafting was performed under general anesthesia (GA) (Group GA) in 14 patients and with sedo-analgesia (SA) (Group SA) in 67 patients. EVAR was administered to 75 patients and TEVAR to 6 patients. Eleven of the EVAR patients received GA and 64 received SA. The mean age of the patients was 68.73±8.31 years, and 75 of the patients were male. There was no significant difference between the groups with regards to comorbidities (p>0.05). When the length of stay in the intensive care unit was evaluated in terms of duration of hospitalization, there was no statistically significant difference between the groups (p>0.05).
Conclusion: In this study, GA and SA gave similar outcomes an in patients who underwent EVAR/TEVAR in our clinic, except for the intraoperative fluid requirements.
Kaynakça
- Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843–8.
- Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991 Nov;5(6):491-9.
- Elkouri S, Gloviczki P, McKusick MA, Panneton JM, Andrews J, Bower TC, et al. Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. Journal of vascular surgery. 2004;39(3):497-505.
- Köksal C, Özcan V, Sarıkaya S, Meydan B, Zengin M, Numan F. Torakal ve abdominal aort anevrizmalarının endovasküler tedavisi. Turkish J Thorac Cardiovasc Surg. 2004;12:184-7.
- Franz R, Hartman J, Wright M. Comparison of anesthesia technique on outcomes of endovascular repair of abdominal aortic aneurysms: a five-year review of monitored anesthesia care with local anesthesia vs. general or regional anesthesia. J Cardiovasc Surg (Torino). 2011;52(4):567-77
- Armstrong RA, Squire YG, Rogers CA, Hinchliffe RJ, Mouton R. Type of anesthesia for endovascular abdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth. 2019;33(2):462-71. doi:10.1053/j.jvca.2018.09.018
- Bakker EJ, van de Luijtgaarden KM, van Lier F, Valentijn TM, Hoeks SE, Klimek M, et al. General anaesthesia is associated with adverse cardiac outcome after endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2012 Aug;44(2):121-5. doi: 10.1016/j.ejvs.2012.04.028. Epub 2012 May 22.
- Karthikesalingam A, Thrumurthy SG, Young EL, Hinchliffe RJ, Holt PJ, Thompson MM. Locoregional anesthesia for endovascular aneurysm repair. J Vasc Surg. 2012;56(2):510-9. doi:10.1016/j.jvs.2012.02.047
- Edwards MS, Andrews JS, Edwards AF, Ghanami RJ, Corriere MA, Goodney PP, et al. Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg. 2011;54(5):1273-82. doi: 10.1016/j.jvs.2011.04.054. Epub 2011 Jul 1.
- Kaya S, Turhan Ö, Sungur Z, Sayın ÖA, Alpagut U, Şentürk M. Endovasküler girişimlerde anestezi yönetimi ve klinik sonuçlarının retrospektif değerlendirilmesi. GKDA Derg. 2018;24(4):152-9
- Yağan Ö, Özyılmaz K, Taş N, Hancı V. A retrospective analysis of comparison of general versus regional anaesthesia for endovascular repair of abdominal aortic aneurysm. Turk J Anaesthesiol Reanim. 2015;43(1):35-40. doi: 10.5152/TJAR.2014.47450. Epub 2014 Sep 9.
- Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. 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. doi:10.1016/j.jvs.2006.03.039
- De Virgilio C, Romero L, Donayre C, Meek K, Lewis RJ, Lippmann M, et al. Endovascular abdominal aortic aneurysm repair with general versus local anesthesia: a comparison of cardiopulmonary morbidity and mortality rates. J Vasc Surg. 2002;36(5):988-91. doi: 10.1067/mva.2002.128314.
- Wax DB, Garcia C, Campbell N, Marin ML, Neustein S. Anesthetic experience with endovascular aortic aneurysm repair. Vascular and endovascular surgery. 2010;44(4):279-81.
- Noh M, Choi BM, Kwon H, Han Y, Ko GY, Kwon TW, et al. General anesthesia versus local anesthesia for endovascular aortic aneurysm repair. Medicine (Baltimore). 2018;97(32):e11789.
- Arar C, Sezen Ü, Yüksek A, Sarıkaya H, Turan F, Turan C, et al. Combined spinal-epidural anesthesia or local anesthesia+ sedoanalgesia in abdominal aortic aneurism repair?. Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society. 2015;21(2):95-100.
- Gümüş F, Polat A, Farsak B, Alagöl A. Endovasküler aortik rekonstrüksiyonlarda anestezi yaklaşımı. Koşuyolu Kalp Dergisi. 2013;16(1):25-31.
- Türktan M, Göçen U. Endovasküler aort tamirinde anestezi yaklaşımları: tek merkez deneyimi. Cukurova Medical Journal. 2019;44(4):1256-61.
- Güzel A, Doğan E, Karaman H, Aycan İÖ, Çelik F, Çiftçi T, et al. Aort patolojilerinin endovasküler tedavisinde anestezi yönetimi. Dicle Tıp Derg 2014;41(2):357-63.
- Barbosa AP, Palotti AM. Uso de sedação com cetamina+ dexmedetomedina (Ketodex) para reparo endovascular de aneurisma de aorta abdominal–relato de experiência. Braz J of Heal Rev. 2022;5(1):995-1005.
- Lee A, Shirley M. Remimazolam: A review in procedural sedation. Drugs. 2021;81(10):1193-201. doi: 10.1007/s40265-021-01544-8. Epub 2021 Jul 1.
- Verhoeven EL, Cinà CS, Tielliu IF, Zeebregts CJ, Prins TR, Eindhoven GB, et al. Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2005;42(3):402-9. doi: 10.1016/j.jvs.2005.05.047.
- Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on Eurostar data. J Vasc Surg. 2006;44:16-21.
- Bettex DA, Lachat M, Pfammatter T, Schmidlin D, Turina MI, Schmid ER. To compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR). Eur J Vasc Endovasc Surg. 2001;21(2):179-84. doi: 10.1053/ejvs.2000.1295.
- Parate LH, Channappa NM, Pujari V, Iyer S. Fascia Iliaca block as the sole anesthesia technique in a patient with recent myocardial infarction for emergency femoral thrombectomy. Saudi J Anaesth. 2015;9(2):199-201.
- Harlin SA, Grissom RA, Le Croy C, Pouliot SM, Harlin SA. A Novel Anesthetic Technique for PEVAR. Ann Vasc Surg. 2016;34:106-10.
Endovasküler Aort Anevrizması Onarım Cerrahilerine Anestezist Bakışı; Tek Merkezli Retrospektif Bir Çalışma
Yıl 2023,
Cilt: 18 Sayı: 3, 62 - 68, 20.11.2023
Gamze Ertaş
,
Hamiyet Şenol Çakmak
,
Sevda Akdeniz
,
Ebru Polat
,
İlker Hasan Karal
,
Serkan Tulgar
Öz
Amaç: Minimal invaziv endovasküler stent greftleme yöntemleri olan endovasküler aort onarımı (EVAR) ve torasik endovasküler aort onarımı (TEVAR), aort anevrizmalarının tedavisinde geleneksel ve invaziv açık cerrahiye alternatif olarak uygulanmaktadır. Bu çalışmanın amacı hastanemizde EVAR ve TEVAR uygulanan hastalarda uygulanan anestezi yöntemlerini değerlendirmektir.
Gereç ve Yöntemler: Çalışmamızda 01.01.2015-31.05.2022 tarihleri arasında endovasküler aort onarımı yapılan 95 hastanın dosyaları geriye dönük olarak incelendi. Hastalara ilişkin tanımlayıcı verilerin yanı sıra ameliyat süresi, yoğun bakım ve hastanede kalış süresi gibi veriler toplanarak değerlendirildi.
Bulgular: Endovasküler aortik greftlemenin 14 hastaya genel anestezi (GA) (Grup GA) altında, 67 hastaya sedo-analjezi (SA) (Grup SA) altında yapıldığı belirlendi. 75 hastaya EVAR, 6 hastaya TEVAR uygulandı. EVAR hastalarının 11'inin GA, 64'ünün SA ile tedavi edildiği görüldü. Hastaların yaş ortalaması 68.73±8.31 yıl olup, 75'i erkekti. Hasta komorbiditeleri göz önüne alındığında gruplar arasında anlamlı fark yoktu (p>0.05). Yoğun bakımda kalış süreleri hastanede kalış süreleri açısından değerlendirildiğinde gruplar arasında istatistiksel olarak anlamlı fark bulunmadı (p>0.05).
Sonuç: Bu çalışmada kliniğimizde EVAR/TEVAR uygulanan hastalarda intraoperatif sıvı gereksinimi dışında anestezi yönteminin üstünlüğünü belirleyemedik.
Kaynakça
- Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843–8.
- Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991 Nov;5(6):491-9.
- Elkouri S, Gloviczki P, McKusick MA, Panneton JM, Andrews J, Bower TC, et al. Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. Journal of vascular surgery. 2004;39(3):497-505.
- Köksal C, Özcan V, Sarıkaya S, Meydan B, Zengin M, Numan F. Torakal ve abdominal aort anevrizmalarının endovasküler tedavisi. Turkish J Thorac Cardiovasc Surg. 2004;12:184-7.
- Franz R, Hartman J, Wright M. Comparison of anesthesia technique on outcomes of endovascular repair of abdominal aortic aneurysms: a five-year review of monitored anesthesia care with local anesthesia vs. general or regional anesthesia. J Cardiovasc Surg (Torino). 2011;52(4):567-77
- Armstrong RA, Squire YG, Rogers CA, Hinchliffe RJ, Mouton R. Type of anesthesia for endovascular abdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth. 2019;33(2):462-71. doi:10.1053/j.jvca.2018.09.018
- Bakker EJ, van de Luijtgaarden KM, van Lier F, Valentijn TM, Hoeks SE, Klimek M, et al. General anaesthesia is associated with adverse cardiac outcome after endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2012 Aug;44(2):121-5. doi: 10.1016/j.ejvs.2012.04.028. Epub 2012 May 22.
- Karthikesalingam A, Thrumurthy SG, Young EL, Hinchliffe RJ, Holt PJ, Thompson MM. Locoregional anesthesia for endovascular aneurysm repair. J Vasc Surg. 2012;56(2):510-9. doi:10.1016/j.jvs.2012.02.047
- Edwards MS, Andrews JS, Edwards AF, Ghanami RJ, Corriere MA, Goodney PP, et al. Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg. 2011;54(5):1273-82. doi: 10.1016/j.jvs.2011.04.054. Epub 2011 Jul 1.
- Kaya S, Turhan Ö, Sungur Z, Sayın ÖA, Alpagut U, Şentürk M. Endovasküler girişimlerde anestezi yönetimi ve klinik sonuçlarının retrospektif değerlendirilmesi. GKDA Derg. 2018;24(4):152-9
- Yağan Ö, Özyılmaz K, Taş N, Hancı V. A retrospective analysis of comparison of general versus regional anaesthesia for endovascular repair of abdominal aortic aneurysm. Turk J Anaesthesiol Reanim. 2015;43(1):35-40. doi: 10.5152/TJAR.2014.47450. Epub 2014 Sep 9.
- Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. 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. doi:10.1016/j.jvs.2006.03.039
- De Virgilio C, Romero L, Donayre C, Meek K, Lewis RJ, Lippmann M, et al. Endovascular abdominal aortic aneurysm repair with general versus local anesthesia: a comparison of cardiopulmonary morbidity and mortality rates. J Vasc Surg. 2002;36(5):988-91. doi: 10.1067/mva.2002.128314.
- Wax DB, Garcia C, Campbell N, Marin ML, Neustein S. Anesthetic experience with endovascular aortic aneurysm repair. Vascular and endovascular surgery. 2010;44(4):279-81.
- Noh M, Choi BM, Kwon H, Han Y, Ko GY, Kwon TW, et al. General anesthesia versus local anesthesia for endovascular aortic aneurysm repair. Medicine (Baltimore). 2018;97(32):e11789.
- Arar C, Sezen Ü, Yüksek A, Sarıkaya H, Turan F, Turan C, et al. Combined spinal-epidural anesthesia or local anesthesia+ sedoanalgesia in abdominal aortic aneurism repair?. Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society. 2015;21(2):95-100.
- Gümüş F, Polat A, Farsak B, Alagöl A. Endovasküler aortik rekonstrüksiyonlarda anestezi yaklaşımı. Koşuyolu Kalp Dergisi. 2013;16(1):25-31.
- Türktan M, Göçen U. Endovasküler aort tamirinde anestezi yaklaşımları: tek merkez deneyimi. Cukurova Medical Journal. 2019;44(4):1256-61.
- Güzel A, Doğan E, Karaman H, Aycan İÖ, Çelik F, Çiftçi T, et al. Aort patolojilerinin endovasküler tedavisinde anestezi yönetimi. Dicle Tıp Derg 2014;41(2):357-63.
- Barbosa AP, Palotti AM. Uso de sedação com cetamina+ dexmedetomedina (Ketodex) para reparo endovascular de aneurisma de aorta abdominal–relato de experiência. Braz J of Heal Rev. 2022;5(1):995-1005.
- Lee A, Shirley M. Remimazolam: A review in procedural sedation. Drugs. 2021;81(10):1193-201. doi: 10.1007/s40265-021-01544-8. Epub 2021 Jul 1.
- Verhoeven EL, Cinà CS, Tielliu IF, Zeebregts CJ, Prins TR, Eindhoven GB, et al. Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2005;42(3):402-9. doi: 10.1016/j.jvs.2005.05.047.
- Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on Eurostar data. J Vasc Surg. 2006;44:16-21.
- Bettex DA, Lachat M, Pfammatter T, Schmidlin D, Turina MI, Schmid ER. To compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR). Eur J Vasc Endovasc Surg. 2001;21(2):179-84. doi: 10.1053/ejvs.2000.1295.
- Parate LH, Channappa NM, Pujari V, Iyer S. Fascia Iliaca block as the sole anesthesia technique in a patient with recent myocardial infarction for emergency femoral thrombectomy. Saudi J Anaesth. 2015;9(2):199-201.
- Harlin SA, Grissom RA, Le Croy C, Pouliot SM, Harlin SA. A Novel Anesthetic Technique for PEVAR. Ann Vasc Surg. 2016;34:106-10.