Anesthesia management for total endovascular aortic arch repair: A case series

The average length of ICU stay post-op for the remaining five patients was five days and the total hospital length of stay was 7.2 days. A review of the recently published observational studies comparing the complication rates between the hybrid endovascular approach and open total arch repair demonstrates that in-hospital mortality and permanent stroke risk are comparable in both groups. [5] In the event of failed pacing during graft deployment, transient deliberate hypotension (systolic blood pressure < 60 mmHg) may be highly beneficial to prevent stent migration and embolization. Case Procedure Surgical access Case duration (min) Estimated blood loss (ml) Blood transfusion 1 Total percutaneous endovascular repair of aortic arch aneurysm and distal thoracic aorta using patient specific three-vessel Cook manufactured arch branch stent graft Bilateral percutaneous femoral approach using pre-closure technique with Perclose device, use of the steerable sheath system with total transfemoral axis to all 3 supraaortic trunks 230 200 No 2 Endovascular repair of thoracic aortic aneurysm using patient specific distal arch branch device with left subclavian retrograde branch and triple wide scallop for the left common carotid artery, left subclavian artery stenting, and left innominate artery stenting Bilateral percutaneous retrograde femoral approach 197 100 No 3 Percutaneous closure of pseudoaneurysm with placement of plug, selective catheterization of arch pseudoaneurysm, and aortic angiography Right percutaneous retrograde femoral access 103 100 No 4 Fenestrated endovascular repair of aortic arch aneurysm using patient specific three-vessel Cook manufactured arch branch stent graft Bilateral percutaneous retrograde femoral approach 214 300 No 5 Endovascular repair of aortic arch aneurysm using patient specific three-vessel Cook manufactured arch branch stent graft Right percutaneous transaxillary approach with further closure device and bilateral percutaneous femoral approach using pre-closure technique with Perclose device 286 200 No 6 Endovascular repair of aortic arch aneurysm using patient specific three-vessel Cook manufactured arch branch stent graft Bilateral percutaneous femoral approach using pre-closure technique with Perclose device, bilateral cervical oblique incisions for exposure, sequential clamping and access of the common carotid arteries 157 200 No