| Popis: |
Abdominal Aortic Aneurysm (AAA) is a disease associated with hypercholesterolemia, peripheral artery disease, smoking, hypertension, and an unhealthy lifestyle. It has preponderance for male gender and its prevalence increases 2–4% per decade of life after age 55–60 and is often an incidental finding. The risk of rupture increases progressively when vessel diameter reaches 5 cm. Despite current development in surgical techniques and transition to endovascular abdominal aneurysm repairs (EVAR) in more than 70% of patients with this diagnosis, this procedure can lead to major complications and mortality. Moreover, patients who are initially selected to undergo EVAR are generally sicker with higher ASA status, and emergency surgery for ruptured AAA may be managed with endovascular repair. While short-term results favor EVAR, in the long term these patients require more frequent monitoring, and the need for secondary interventions for graft complication with increasing costs without improved long-term mortality is observed. Practicing anesthesiologists should be familiar with the different approaches to EVAR and with the considerations to guide intraoperative management and anesthetic choice. The abundant use of fluoroscopy and intravenous dye can pose significant risk and physiological burden on the patient. Anesthesiologists should be familiar with the different types of endoleaks and their consequences, as these patients will present with some frequency for operative management after initial endovascular repair. |
