3.7 EVAR Flashcards
Anaesthetic Techniques
Invasive Arterial Monitoring
Usually R Rad cannulation
rad access to left ax artery is required
Large bore IV access
Urinary cathter
CVP not routinely required
Surgery performed combo surg / rad suite
can be separate site with delayed support / senior help
Bilateral Longitudinal incision
expose Fem Artery
Stent deployment
Technique
Research ?advantage RA >GA
Reduction ICU bed usage
Hospital LOS
Postop morbidity - RF
Mortality
Local Anaesthesia
Adequate for topical analgesia
Local filtration
Risk of poorer patient compliance
Avoids complications GA
Lower incidence renal failure
Regional Anaesthesia
+- Sedation / TCI prop
- Subarachnoid
- single or contin - CSE
- Epidural
Latter 2 allow top ups
long cases
Use post op analgesia
PeriOp anticoagulation required
Risk Neuraxial haematoma
Compliance important
During screen for typ1 endoleak
-failure stent graft to seal at proximal and disital landing zone
patient must be still and hold breath
Challenge of compliance for extended cases
GA
Significant CVS comorb
make Ra pref
Preop assessment of suitability for GA reqd
Avoids
patient awake and stress
Time constraints
Requires additional post op analgesia
Complications of EVAR
Immediate
Early
Delayed
Immediate
Aneurysm rupture
Conversion to Open (2%)
Endoleak
failure to isolate aneurysm sac with graft
(5-10%)
Vessel dissection
Poor distal flow and ischaemia
Distal Emboli
Neurological insult
ASA occlusion
S.Cord infarct
Early
Periop + Postop arrhythmias
MI
Cardiac failure
Resp complications
Lobar collapse / hypoxia / pneumonia
Peri and post op renal failure
Endoleak
Graft occlusion / displacement
Post implantation syndrome
Fever / Elevated CRP WCC
absence infection
2-10/7 response to NSAID
Delayed
Stent displacement
Stent Fracture
VTE
Recurrence aneurysm
EVAR Trials
instigated assess safety AAA Rx w/ evar
Mortality / QO / Durability ? Cost
EVAR 1 - Fit for open
2 Unfit for open
NICE guideline reserved for elective patients
not for ruptures
