ABSTRACT
Objective To explore the morbidity and possible mechanism of spinal cord ischemia (SCI) after infrarenal abdominal aortic aneurysm (IAAA) endovascular aneurysm repair (EVAR). Methods We retrospectively analyzed the intraoperative hypogastric artery occlusion and postoperative SCI of 400 patients who received EVAR in the Departments of Vascular and Endovascular Surgery of Shanghai Changhai Hospital and Changzheng Hospital from January 2008 to October 2014. The morbidity and possible mechanism of SCI after EVAR were analyzed while combining the existing literatures. Results Bilateral hypogastric arteries were obstructed during operation in 60 patients (unilateral hypogastric artery aneurysms were embolized by spring coil in 8 cases); unilateral hypogastric arteries was obstructed in 70 patients (unilateral hypogastric artery aneurysms were partially embolized by spring coil in 10 cases). Postoperatively 2 cases had acute lower limb artery ischemia, 1 had acute SCI, and 1 had chronic lower limb lameness(> 3 months). The incidence of SCI was 0. 25% (1/400). Existing literatures showed that the incidence of SCI following EVAR was 0. 21%-0. 38%, and only 1 of the 14 cases with SCI was thought to be associated with the hypogastric artery— interruption. Conclusion SCI is a very rare postoperative complication of EVAR, with the mechanism remaining unknown. The occlusion of hypogastric artery may play a part, but existing literatures suggest a noncore role. In addition to ischemia caused by SCI and embolization, the perioperative general condition of patients also needs to be taken into consideration.
ABSTRACT
This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysms undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All 4 patients were males with a mean age of 66.7 years. Only one (1) required ICU stay of 2 days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).
ABSTRACT
The repair of abdominal aortic aneurysm (AAA) in the presence of significant coronary artery disease (CAD) carries a high-risk of adverse peri-operative cardiac event. The options to reduce cardiac risk include perioperative β-blockade, preoperative optimization by myocardial revascularization and simultaneous (combined) coronary artery bypass grafting and aneurysm repair. We describe intra-operative controlled phlebotomy to optimize myocardial stress during repair of infrarenal AAA in a patient with significant stable CAD.