İnfrarenal ve Torasik Abdominal Aort Anevrizmalarına Lokal Anestezi ile Sedasyon Altında Endovasküler Anevrizma Onarımı
Abstract
Amaç: Bu çalışmanın amacı infrarenal aort anevrizma ve torasik aort anevrizmalı hastalarda lokal
anestezi ile sedasyon eşliğinde endovasküler anevrizma tamiri deneyiminin raporlanmasıdır.
Materyal ve Metod: Temmuz 2011 ve temmuz 2013 arsında 8 hasta departmanımızda lokal
anestezi ve kontrollü sedasyon eşliğinde endovasküler anevrizma tamiri uygulandı. Lokal anestezi 2%
Prilokain infiltrasyonu ile sağlandı ve sedasyon ise intravenöz midazolam 0.05 - 0.2 mg/kg IV, fentanyl
50-150 microgram IV bolus, and propofol 25-75 microgram /kg bolus ile temin edildi.
Bulgular: Endovasküler anevrizma tamiri 6 infrarenal aort anevrizması ve 2 torasik aort
anevrizması hastalarına uygulandı. Mortalite veya major postoperatif morbidite kaydedilmedi ve işlem
sonrası ortlama hastanede kalış süresi 3,2 gün ( 2-5 gün) idi. Bütün hastaların bir yıllık takiplerinde
mortalite veya rekürrens izlenmedi.
Sonuç: Endovasküler anevrizma tamiri kritik hastalarda güvenli prosedürdür ve kolaylıkla lokal
anestezi ve sedasyon altında uygulanabilir. Bu prosedürde lokal anestezi ile sedasyon anestezi
yönetiminde bir alternatif olabilir.
References
- 1. Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev. 2014 23;(1):CD004178. doi: 10.1002/14651858. 2. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysm. Ann Vasc Surg 1991;5(6):491-9. 3. Abraha I, Romagnoli C, Montedori A, Cirocchi R. Thoracic stent graft versus surgery for thoracic aneurysm. Cochrane Database Syst Rev. 2013;11;9:CD006796. doi: 10.1002/14651858 4. Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev.2014 Jan 23;(1):CD004178. doi: 10.1002/14651858.CD004178.pub2. 5. Nienaber CA, Fattori R, Lund G, Dieckmann C, Wolf W, von Kodolitsch Y, Nicolas V, Pierangeli A. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999; 340(20):1539- 45. 6. Cao P, Zannettti S, Parlani G Vernizzi F, CarporaliS, Spaccatini A, et al. Epidural anaesthesia reduces length of hospitalization after endoluminal abdominal aortic aneurysm repair. J Vasc Surg 1999;30(4): 651-7. 7. Verhoeven ELG, Cina CS, Tielliu IFJ, Zeebregts CJ, Prins TR, Eind- hoven GB, et al. Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2005;42: 402-9. 8. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. 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. 9. 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;351:1607-18. 10. Chaikof EL, Brewster DC, Dalman RL, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009;50(4 supp):S2e49. 11. Henretta JP, Hodgson KJ, Mattos MA, Karch LA, Hurlbert SN, Stembarch Y, et al. Feasibility of endovascular repair of abdominal aoric aneurysm with local anaesthesia with intravenous sedation. J vasc Surg 1999;29:793- 8. 12. Ruppert V, Leurs LJ, Steckmeier B, et al. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: An analysis based on EUROSTAR data J Vasc Surg 2006;44:16-21. 13. 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.
Endovascular Aneurysm Repair for Infra-renal and Thoracic Abdominal Aort Aneurysms Under Local Anesthesia with Sedation
Abstract
Background: This study aims to report our experience of endovascular aneurysm repair with LA
and sedation in patients with infra-renal aortic aneurysm and thoracic aorta aneurysm.
Materials and Methods: Between July 2011 and July 2013, 8 patients underwent endovascular
aneurysm repair with local anesthesia and controlled sedation in our department. Local anesthesia was
achieved by infiltrating 2% Prilocain and for the sedation was provided by intravenous midazolam 0.05 -
0.2 mg/kg IV, fentanyl 50-150 microgram IV bolus, and propofol 25-75 microgram /kg bolus.
Results: Endovascular aneurysm repair was used in six patients infra-renal aortic aneurysm and
two patients thoracic aorta aneurysm. No mortality or major post operative morbidity was recorded and the
mean hospital stay post procedure was 3.2 days (range 2-5 days). One year follow-up all patient no
mortality or recurrence was observed.
Conclusion: Endovascular aneurysm repair are safe procedure in critical patient and easily done
under local anesthesia and sedation. LA with sedation in this procedure might be an alternative in
anesthetic management.
References
- 1. Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev. 2014 23;(1):CD004178. doi: 10.1002/14651858. 2. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysm. Ann Vasc Surg 1991;5(6):491-9. 3. Abraha I, Romagnoli C, Montedori A, Cirocchi R. Thoracic stent graft versus surgery for thoracic aneurysm. Cochrane Database Syst Rev. 2013;11;9:CD006796. doi: 10.1002/14651858 4. Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev.2014 Jan 23;(1):CD004178. doi: 10.1002/14651858.CD004178.pub2. 5. Nienaber CA, Fattori R, Lund G, Dieckmann C, Wolf W, von Kodolitsch Y, Nicolas V, Pierangeli A. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999; 340(20):1539- 45. 6. Cao P, Zannettti S, Parlani G Vernizzi F, CarporaliS, Spaccatini A, et al. Epidural anaesthesia reduces length of hospitalization after endoluminal abdominal aortic aneurysm repair. J Vasc Surg 1999;30(4): 651-7. 7. Verhoeven ELG, Cina CS, Tielliu IFJ, Zeebregts CJ, Prins TR, Eind- hoven GB, et al. Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2005;42: 402-9. 8. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. 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. 9. 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;351:1607-18. 10. Chaikof EL, Brewster DC, Dalman RL, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009;50(4 supp):S2e49. 11. Henretta JP, Hodgson KJ, Mattos MA, Karch LA, Hurlbert SN, Stembarch Y, et al. Feasibility of endovascular repair of abdominal aoric aneurysm with local anaesthesia with intravenous sedation. J vasc Surg 1999;29:793- 8. 12. Ruppert V, Leurs LJ, Steckmeier B, et al. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: An analysis based on EUROSTAR data J Vasc Surg 2006;44:16-21. 13. 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.
Details
| Primary Language | English |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 28, 2017 |
| Submission Date | June 28, 2016 |
| Acceptance Date | July 18, 2016 |
| Published in Issue | Year 2017 Volume: 14 Issue: 1 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty