Changes in cardiac output during major vascular surgery

Anesthesia for Open Abdominal Aortic Aneurysm Repair

Abdominal aortic aneurysms (AAAs) are the 13th leading cause of death in the United States 1 and approximately 40,000 patients undergo elective AAA repair each year.2 With the population aging, this number is expected to increase. Although the use of endovascular AAA repair is becoming more common, open repair, first reported by Dubost et al. in 1951 remains the gold standard.2 This chapter will review the etiology, risk factors, diagnosis, pathophysiology, operative technique, perioperative management, and postoperative complications of patients undergoing open AAA repair.

Intraoperative management of abdominal aortic aneurysms. The anesthesiologist's viewpoint

Factors that influence the choice of anesthetic, monitoring methods, and fluid management for aneurysm repair are reviewed, with particular attention to epidural anesthesia and analgesia and the pulmonary artery catheter. Management of bleeding, renal preservation, temperature control, and myocardial ischemia are discussed, and special anesthetic issues associated with ruptured aneurysms and juxtarenal and suprarenal surgery are summarized.

The influence of collateral vascularisation on haemodynamic performance during abdominal aortic surgery

The extent of periaortic collateral vascularisation has been proposed as a possible mechanism of an altered haemodynamic response to infra-renal aortic cross-clamp in patients undergoing by-pass grafting for aorto-iliac occlusive disease (AOD) compared with patients undergoing abdominal aortic aneurysm (AAA) resection. The haemodynamic responses following clamping, during the clamp time and following clamp release were studied in 18 patients undergoing AAA resection and 12 patients undergoing bypass grafting for AOD. The role of preoperative aortography in predicting cardiovascular performance during aortic vascular surgery was assessed. During the cross-clamp period LVSWI and CI decreased while SVR increased in the AAA group while the AOD group showed an improved CI, stable LVSWI and reduced SVR, which correlated with the extent of periaortic vascularisation on preoperative aortography. Chronic collateral circulation associated with AOD may permit continuous lower extremity perfusion during aortic cross-clamp. The extent of periaortic collateralisation may influence the choice of monitoring techniques and anaesthetic management.