Anesthesia for other endovascular stenting

Diagnostic and therapeutic endovascular stenting tended to expand in the last decade. The anesthetist may be asked to participate in the management of these patients with severe associated comorbidities complicating the delivery of anesthesia. This review describes current vascular stentings performed in the radiology suite and their relevant consequences interesting the anesthetist.

Most of these procedures can be performed under local anesthesia associated or not with moderate sedation. Carotid stenting is as well tolerated as carotid surgery but those selected patients who may benefit from it are not clearly identified. Endovascular stenting of the aorta avoids major surgical trauma and decreases its consequences. The procedure requires light anesthesia but careful monitoring. Prior thoracic aortic replacement and the length of zone numbers covered by the stent graft are risk factors for spinal ischemia that may lead to paraplegia. Cerebrospinal fluid drainage, evoked potential, and S100 beta monitoring may help to prevent this complication or detect it earlier. Transjugular intrahepatic portosystemic shunt is efficient in treating acute variceal bleeding and for secondary prevention. Postoperative encephalopathy represents the main postprocedural complication.

Literature review provides little information about anesthetic management of extracranial endovascular stentings. Knowledge of indication and consequences is mandatory for anesthetists in charge of these patients.