Anesthesia for endovascular repair of abdominal and thoracic aortic aneurysms: a review article

Open repair of abdominal aortic aneurysms (AAA) and thoracic aortic aneurysms (TAA) are associated with significant morbidity and mortality. Endovascular aortic aneurysm repair (EVAAR) using a stent graft is a new alternative to traditional open repair. There are various types of anesthesia which can be utilized for EVAAR; specifically general endotracheal anesthesia, regional anesthesia, and monitored anesthesia care (MAC) with local anesthetic infiltrated at the incision site. Choice of anesthetic technique may be dependent upon a patient's co-existing diseases. We have prepared a review article discussing the various types of anesthesia available for this procedure, including the specifics of each technique and pros and cons of each option. The most often utilized technique appears to be general anesthesia, often times related to surgeon unfamiliarity with the EVAAR procedure. Regional techniques, including continuous epidural or continuous spinal anesthesia are utilized in some cases with very good results. This technique can provide more hemodynamic stability and better pain control than general alternative, MAC with local, is an extremely safe and effective technique for the EVAAR procedure, especially in patients with severe co-existing diseases. In addition, this technique also minimalizes sedation and post-operative analgesic requirements, decreases cardiopulmonary complications, and decreases overall hospital stay, thereby reducing cost.