Open Abdominal Aortic Aneurysm Replacement in the Awake Patient.

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Vascular Surgery

Background:

• Awake aortic surgery, while reported, is not widely adopted despite positive outcomes in specific patient populations.
• High-risk patients with abdominal aortic aneurysms (AAA) unsuitable for endovascular repair pose a surgical challenge.
• Significant respiratory disease can make general anesthesia an unacceptable risk for aortic surgery.

Observation:

• A patient with an abdominal aortic aneurysm (AAA) deemed unsuitable for endovascular repair presented with severe respiratory compromise.
• General anesthesia posed an unacceptably high risk due to the patient's pre-existing respiratory condition.

Findings:

• Open abdominal aortic aneurysm (AAA) repair was successfully performed via a retroperitoneal approach.
• Epidural anesthesia was utilized, allowing the patient to remain awake during the procedure.
• This approach facilitated life-saving surgery for a patient with limited anesthetic options.

Implications:

• Awake aortic surgery using epidural anesthesia is a feasible and potentially life-saving option for select patients with AAA.
• This technique offers an alternative for patients with contraindications to general anesthesia.
• Highlights the benefits of regional anesthesia in complex aortic interventions.