Hennessy Martin, Hussey Keith Kelso
Departments of Interventional Radiology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK.
Departments of Vascular Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK.
Vasc Specialist Int. 2023 Mar 24;39:3. doi: 10.5758/vsi.230003.
We aimed to describe our technique for and experience with elective endovascular aneurysm repair using EndoAnchors under local anesthesia.
We included seven patients with abdominal aortic aneurysms who underwent endovascular aneurysm repair using EndoAnchors with a standard regimen consisting of local anesthesia, intravenous sedation, and analgesia. The procedural and follow-up details were retrospectively reviewed.
Six out of seven infrarenal abdominal aortic aneurysms were successfully treated with endovascular aneurysm repair using primary EndoAnchors under local anesthesia. One patient was converted to general anesthesia due to acute aneurysm thrombosis independent of EndoAnchor deployment during the procedure. Remifentanyl infusions of up to 3.2 mg/min, morphine doses up to 6 mg (median, 0.5 mg), and midazolam doses of up to 4 mg (mean, 1.4 mg) were used. The mean theater time was 83 minutes (range, 60-130 minutes). Two patients were discharged on day 0, and the mean hospital stay was one day. All patients were alive between 484 and 1,128 days post-procedure, with no aneurysm-specific reintervention.
The combination of local anesthesia, intravenous sedation, and analgesia is a viable strategy for timely and effective endovascular aneurysm repair using EndoAnchors. This technique may allow endovascular repair of more ruptured aneurysms using EndoAnchors with potential survival benefits.
我们旨在描述在局部麻醉下使用EndoAnchors进行选择性血管内动脉瘤修复的技术及经验。
我们纳入了7例腹主动脉瘤患者，他们接受了使用EndoAnchors的血管内动脉瘤修复术，采用由局部麻醉、静脉镇静和镇痛组成的标准方案。对手术及随访细节进行了回顾性分析。
7例肾下腹主动脉瘤中有6例在局部麻醉下使用原发性EndoAnchors成功进行了血管内动脉瘤修复。1例患者因术中与EndoAnchor部署无关的急性动脉瘤血栓形成而转为全身麻醉。使用了高达3.2mg/min的瑞芬太尼输注、高达6mg（中位数，0.5mg）的吗啡剂量和高达4mg（平均，1.4mg）的咪达唑仑剂量。平均手术时间为83分钟（范围，60 - 130分钟）。2例患者在术后第0天出院，平均住院时间为1天。所有患者在术后484至1128天均存活，无动脉瘤特异性再次干预。
局部麻醉、静脉镇静和镇痛相结合是使用EndoAnchors及时有效地进行血管内动脉瘤修复的可行策略。该技术可能允许使用EndoAnchors对更多破裂动脉瘤进行血管内修复，具有潜在的生存益处。
