İnfrarenal ve Torasik Abdominal Aort Anevrizmalarına Lokal Anestezi ile Sedasyon Altında Endovasküler Anevrizma Onarımı
Yıl 2017,
Cilt: 14 Sayı: 1, 36 - 45, 28.04.2017
Mehmet Salih Aydın
Aydemir Koçarslan
,
Abdussemet Hazar
Ahmet Küçük
,
Mustafa Göz
,
Mert Ürküp
Öz
Amaç: Bu çalışmanın amacı infrarenal aort anevrizma ve torasik aort anevrizmalı hastalarda lokal
anestezi ile sedasyon eşliğinde endovasküler anevrizma tamiri deneyiminin raporlanmasıdır.
Materyal ve Metod: Temmuz 2011 ve temmuz 2013 arsında 8 hasta departmanımızda lokal
anestezi ve kontrollü sedasyon eşliğinde endovasküler anevrizma tamiri uygulandı. Lokal anestezi 2%
Prilokain infiltrasyonu ile sağlandı ve sedasyon ise intravenöz midazolam 0.05 - 0.2 mg/kg IV, fentanyl
50-150 microgram IV bolus, and propofol 25-75 microgram /kg bolus ile temin edildi.
Bulgular: Endovasküler anevrizma tamiri 6 infrarenal aort anevrizması ve 2 torasik aort
anevrizması hastalarına uygulandı. Mortalite veya major postoperatif morbidite kaydedilmedi ve işlem
sonrası ortlama hastanede kalış süresi 3,2 gün ( 2-5 gün) idi. Bütün hastaların bir yıllık takiplerinde
mortalite veya rekürrens izlenmedi.
Sonuç: Endovasküler anevrizma tamiri kritik hastalarda güvenli prosedürdür ve kolaylıkla lokal
anestezi ve sedasyon altında uygulanabilir. Bu prosedürde lokal anestezi ile sedasyon anestezi
yönetiminde bir alternatif olabilir.
Kaynakça
- 1. Paravastu SC, Jayarajasingam R, Cottam R,
Palfreyman SJ, Michaels JA, Thomas SM.
Endovascular repair of abdominal aortic
aneurysm. Cochrane Database Syst Rev. 2014
23;(1):CD004178. doi: 10.1002/14651858.
2. Parodi JC, Palmaz JC, Barone HD.
Transfemoral intraluminal graft implantation for
abdominal aortic aneurysm. Ann Vasc Surg
1991;5(6):491-9.
3. Abraha I, Romagnoli C, Montedori A, Cirocchi
R. Thoracic stent graft versus surgery for
thoracic aneurysm. Cochrane Database Syst
Rev. 2013;11;9:CD006796. doi:
10.1002/14651858
4. Paravastu SC, Jayarajasingam R, Cottam R,
Palfreyman SJ, Michaels JA, Thomas SM.
Endovascular repair of abdominal aortic
aneurysm. Cochrane Database Syst Rev.2014
Jan 23;(1):CD004178. doi:
10.1002/14651858.CD004178.pub2.
5. Nienaber CA, Fattori R, Lund G, Dieckmann
C, Wolf W, von Kodolitsch Y, Nicolas V,
Pierangeli A. Nonsurgical reconstruction of
thoracic aortic dissection by stent-graft
placement. N Engl J Med. 1999; 340(20):1539-
45.
6. Cao P, Zannettti S, Parlani G Vernizzi F,
CarporaliS, Spaccatini A, et al. Epidural
anaesthesia reduces length of hospitalization
after endoluminal abdominal aortic aneurysm
repair. J Vasc Surg 1999;30(4): 651-7.
7. Verhoeven ELG, Cina CS, Tielliu IFJ,
Zeebregts CJ, Prins TR, Eind- hoven GB, et al.
Local anesthesia for endovascular abdominal
aortic aneurysm repair. J Vasc Surg 2005;42:
402-9.
8. Greenhalgh RM, Brown LC, Kwong GP,
Powell JT, Thompson SG. Comparison of
endovascular aneurysm repair with open repair
in patients with abdominal aortic aneurysm
(EVAR trial 1), 30-day operative mortality results:
randomised controlled trial. Lancet
2004;364:843-8.
9. Prinssen M, Verhoeven EL, Buth J, Cuypers
PW, van Sambeek MR, Balm R, et al. A
randomized trial comparing conventional and
endovascular repair of abdominal aortic
aneurysms. N Engl J Med 2004;351:1607-18.
10. Chaikof EL, Brewster DC, Dalman RL, et al.
The care of patients with an abdominal aortic
aneurysm: the Society for Vascular Surgery
practice guidelines. J Vasc Surg 2009;50(4
supp):S2e49.
11. Henretta JP, Hodgson KJ, Mattos MA, Karch
LA, Hurlbert SN, Stembarch Y, et al. Feasibility
of endovascular repair of abdominal aoric
aneurysm with local anaesthesia with
intravenous sedation. J vasc Surg 1999;29:793-
8.
12. Ruppert V, Leurs LJ, Steckmeier B, et al.
Influence of anesthesia type on outcome after
endovascular aortic aneurysm repair: An
analysis based on EUROSTAR data J Vasc Surg
2006;44:16-21.
13. Bettex DA, Lachat M, Pfammatter T,
Schmidlin D, Turina MI, Schmid ER. To compare
general, epidural and local anaesthesia for
endovascular aneurysm repair (EVAR). Eur J
Vasc Endovasc Surg. 2001;21(2):179-84.
Endovascular Aneurysm Repair for Infra-renal and Thoracic Abdominal Aort Aneurysms Under Local Anesthesia with Sedation
Yıl 2017,
Cilt: 14 Sayı: 1, 36 - 45, 28.04.2017
Mehmet Salih Aydın
Aydemir Koçarslan
,
Abdussemet Hazar
Ahmet Küçük
,
Mustafa Göz
,
Mert Ürküp
Öz
Background: This study aims to report our experience of endovascular aneurysm repair with LA
and sedation in patients with infra-renal aortic aneurysm and thoracic aorta aneurysm.
Materials and Methods: Between July 2011 and July 2013, 8 patients underwent endovascular
aneurysm repair with local anesthesia and controlled sedation in our department. Local anesthesia was
achieved by infiltrating 2% Prilocain and for the sedation was provided by intravenous midazolam 0.05 -
0.2 mg/kg IV, fentanyl 50-150 microgram IV bolus, and propofol 25-75 microgram /kg bolus.
Results: Endovascular aneurysm repair was used in six patients infra-renal aortic aneurysm and
two patients thoracic aorta aneurysm. No mortality or major post operative morbidity was recorded and the
mean hospital stay post procedure was 3.2 days (range 2-5 days). One year follow-up all patient no
mortality or recurrence was observed.
Conclusion: Endovascular aneurysm repair are safe procedure in critical patient and easily done
under local anesthesia and sedation. LA with sedation in this procedure might be an alternative in
anesthetic management.
Kaynakça
- 1. Paravastu SC, Jayarajasingam R, Cottam R,
Palfreyman SJ, Michaels JA, Thomas SM.
Endovascular repair of abdominal aortic
aneurysm. Cochrane Database Syst Rev. 2014
23;(1):CD004178. doi: 10.1002/14651858.
2. Parodi JC, Palmaz JC, Barone HD.
Transfemoral intraluminal graft implantation for
abdominal aortic aneurysm. Ann Vasc Surg
1991;5(6):491-9.
3. Abraha I, Romagnoli C, Montedori A, Cirocchi
R. Thoracic stent graft versus surgery for
thoracic aneurysm. Cochrane Database Syst
Rev. 2013;11;9:CD006796. doi:
10.1002/14651858
4. Paravastu SC, Jayarajasingam R, Cottam R,
Palfreyman SJ, Michaels JA, Thomas SM.
Endovascular repair of abdominal aortic
aneurysm. Cochrane Database Syst Rev.2014
Jan 23;(1):CD004178. doi:
10.1002/14651858.CD004178.pub2.
5. Nienaber CA, Fattori R, Lund G, Dieckmann
C, Wolf W, von Kodolitsch Y, Nicolas V,
Pierangeli A. Nonsurgical reconstruction of
thoracic aortic dissection by stent-graft
placement. N Engl J Med. 1999; 340(20):1539-
45.
6. Cao P, Zannettti S, Parlani G Vernizzi F,
CarporaliS, Spaccatini A, et al. Epidural
anaesthesia reduces length of hospitalization
after endoluminal abdominal aortic aneurysm
repair. J Vasc Surg 1999;30(4): 651-7.
7. Verhoeven ELG, Cina CS, Tielliu IFJ,
Zeebregts CJ, Prins TR, Eind- hoven GB, et al.
Local anesthesia for endovascular abdominal
aortic aneurysm repair. J Vasc Surg 2005;42:
402-9.
8. Greenhalgh RM, Brown LC, Kwong GP,
Powell JT, Thompson SG. Comparison of
endovascular aneurysm repair with open repair
in patients with abdominal aortic aneurysm
(EVAR trial 1), 30-day operative mortality results:
randomised controlled trial. Lancet
2004;364:843-8.
9. Prinssen M, Verhoeven EL, Buth J, Cuypers
PW, van Sambeek MR, Balm R, et al. A
randomized trial comparing conventional and
endovascular repair of abdominal aortic
aneurysms. N Engl J Med 2004;351:1607-18.
10. Chaikof EL, Brewster DC, Dalman RL, et al.
The care of patients with an abdominal aortic
aneurysm: the Society for Vascular Surgery
practice guidelines. J Vasc Surg 2009;50(4
supp):S2e49.
11. Henretta JP, Hodgson KJ, Mattos MA, Karch
LA, Hurlbert SN, Stembarch Y, et al. Feasibility
of endovascular repair of abdominal aoric
aneurysm with local anaesthesia with
intravenous sedation. J vasc Surg 1999;29:793-
8.
12. Ruppert V, Leurs LJ, Steckmeier B, et al.
Influence of anesthesia type on outcome after
endovascular aortic aneurysm repair: An
analysis based on EUROSTAR data J Vasc Surg
2006;44:16-21.
13. Bettex DA, Lachat M, Pfammatter T,
Schmidlin D, Turina MI, Schmid ER. To compare
general, epidural and local anaesthesia for
endovascular aneurysm repair (EVAR). Eur J
Vasc Endovasc Surg. 2001;21(2):179-84.