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Berger C, Greiner A, Brandhorst P, Reimers SC, Kniesel O, Omran S, Treskatsch S. How Would I Treat My Own Thoracoabdominal Aortic Aneurysm: Perioperative Considerations From the Anesthesiologist Perspective. J Cardiothorac Vasc Anesth 2024; 38:1092-1102. [PMID: 38310068 DOI: 10.1053/j.jvca.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 02/05/2024]
Abstract
A thoracoabdominal aortic aneurysm (TAAA) can be potentially life-threatening due to its associated risk of rupture. Thoracoabdominal aortic aneurysm repair, performed as endovascular repair and/or open surgery, is the recommended therapy of choice. Hemodynamic instability, severe blood loss, and spinal cord or cerebral ischemia are some potential hazards the perioperative team has to face during these procedures. Therefore, preoperative risk assessment and intraoperative anesthesia management addressing these potential hazards are essential to improving patients' outcomes. Based on a presented index case, an overview focusing on anesthetic measures to identify perioperatively and manage these risks in TAAA repair is provided.
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Affiliation(s)
- Christian Berger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Vascular Surgery, Berlin, Germany
| | - Philipp Brandhorst
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Sophie Claire Reimers
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Olaf Kniesel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Safwan Omran
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Vascular Surgery, Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Yamada Y, Ohki T, Toya N, Ito E, Nakagawa H. Fenestrated Thoracic Endovascular Repair for Acute Type B Aortic Dissection with Isolated Left Vertebral Artery: A Case Report. Ann Vasc Dis 2024; 17:55-58. [PMID: 38628937 PMCID: PMC11018099 DOI: 10.3400/avd.cr.23-00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/26/2023] [Indexed: 04/19/2024] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) of acute uncomplicated type B aortic dissection (uTBAD) has been discussed for its potential to prevent future aortic events. We present a fenestrated TEVAR in the case of an 86-year-old man with acute uTBAD with an isolated left vertebral artery (ILVA). The ILVA originated from the distal side of the left subclavian artery, the left subclavian artery, and the intramural hematoma with an ulcer-like projection extended close to the left subclavian artery. We selected a fenestrated stent graft to achieve a proximal healthy landing. This case demonstrates that a fenestrated stent graft for acute uTBAD is useful for preserving arch vessels.
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Affiliation(s)
- Yuta Yamada
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Toya
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Hikaru Nakagawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
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Ruiter Kanamori L, Mulatti GC, de Barros TCG, Abdalla LG, Le Bihan DCDS, De Luccia N. Endovascular repair of ascending aorta pseudoaneurysm post-extracorporeal membrane oxygenation cannulation during pulmonary transplant. J Vasc Surg Cases Innov Tech 2023; 9:101262. [PMID: 37799845 PMCID: PMC10547737 DOI: 10.1016/j.jvscit.2023.101262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 10/07/2023] Open
Abstract
We demonstrated an endovascular technique excluding an ascending aorta pseudoaneurysm using an aortic extension. A 32-year-old woman, 3 years after lung transplantation with extracorporeal membrane oxygenation presented with an ascending aortic pseudoaneurysm. Vascular surgery was consulted after open repair was deemed high risk. An aortic extension stent graft was placed in a hybrid operating room with the aid of intraoperative transesophageal echocardiography. Ascending aorta pseudoaneurysms are complex and life-threatening complications. Traditional repair involves high surgical and anesthetic risks whereas endovascular treatment is technically feasible.
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Affiliation(s)
- Lucas Ruiter Kanamori
- Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Grace Carvajal Mulatti
- Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Tainá Curado Gomes de Barros
- Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Luis Gustavo Abdalla
- Instituto do Coração, Lung Transplant Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - David Costa de Souza Le Bihan
- Instituto do Coração, Division of Echocardiography, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Nelson De Luccia
- Division of Vascular and Endovascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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Sharma R, Huang Y, Dizdarevic A. Blood Conservation Techniques and Strategies in Orthopedic Anesthesia Practice. Anesthesiol Clin 2022; 40:511-527. [PMID: 36049878 DOI: 10.1016/j.anclin.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Orthopedic surgery procedures involving joint arthroplasty, complex spine, long bone and pelvis procedure, and trauma and oncological cases can be associated with a high risk of bleeding and need for blood transfusion, making efforts to optimize patient care and reduce blood loss very important. Patient blood management programs incorporate efforts to optimize preoperative anemia, develop transfusion protocols and restrictive hemoglobin triggers, advance surgical and anesthesia practice, and use antifibrinolytic therapies. Perioperative management of anticoagulant therapies, a multidisciplinary decision-making task, weighs in risks and benefits of thromboembolic risk and surgical bleeding and is patient- and surgery-specific.
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Affiliation(s)
- Richa Sharma
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA. https://twitter.com/Drsharma_richa
| | - Yolanda Huang
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA
| | - Anis Dizdarevic
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA.
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Jiang J, Zhou R, Li B, Xue F. Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials. J Orthop Surg Res 2019; 14:409. [PMID: 31791362 PMCID: PMC6889611 DOI: 10.1186/s13018-019-1473-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deliberate hypotension has been shown to reduce the intraoperative bleeding and the need for allogeneic blood transfusion, and improve the surgical field, but there is still controversy on its clinical safety. This systematic review was designed to assess the safety and benefits of deliberate hypotension for orthopedic surgery. METHODS The review met the requirements of the PRISMA guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, ISI Web of Science, ScienceDirect, and four Chinese databases (China National Knowledge Infrastructure, Wanfang, vip citation database, and updated version of China Biology Medicine disc from January 1, 2000 to January 1, 2019) were searched. All parallel randomized controlled trials comparing the effects of using deliberate hypotension with not using deliberate hypotension on clinical outcomes of patients undergoing orthopedic surgery were selected. The primary outcome was overall mortality. The secondary outcomes were the intraoperative blood loss, blood transfusion volume, and serious adverse postoperative events. RESULTS A total of 30 studies with 36 comparisons (1454 participants) were included in meta-analysis. Two studies with 120 participants reported overall mortality and the result was zero (low-quality evidence). The use of deliberate hypotension reduced the intraoperative blood loss (mean difference, - 376.7; 95% CI - 428.1 to - 325.3; I2 = 94%; 29 studies, 36 comparisons, and 1398 participants; low-quality evidence) and blood transfusion volume (mean difference, - 242.5; 95% CI - 302.5 to - 182.6; I2 = 95%; 13 studies, 14 comparisons, and 544 participants; low-quality evidence). Six studies with 286 participants reported the occurrence of serious adverse postoperative events and the result was zero (low-quality evidence). Subgroup analyses according to age groups, controlled mean artery pressure levels, types of orthopedic surgeries, different combinations of other blood conservative method, and hypotensive methods mostly did not explain heterogeneity; significant differences were identified in almost all subgroups. CONCLUSIONS Based on the available evidence, it is still unclear whether or not deliberate hypotension is a safe technique for orthopedic surgery due to limited studies with very small sample size, though it may decrease the intraoperative blood loss and blood transfusion volume irrespective of age groups, controlled mean artery pressure levels, types of surgeries, hypotensive methods, or different combinations of other blood conservation strategies. TRIAL REGISTRATION PROSPERO CRD42016045480.
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Affiliation(s)
- Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ran Zhou
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Affiliated with Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Fushan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Sjaus A, Fayad A. The Use of Subcostal Echocardiographic Views to Guide the Insertion of a Right Ventricular Temporary Transvenous Pacemaker—Description of the Technique. J Cardiothorac Vasc Anesth 2019; 33:2797-2803. [DOI: 10.1053/j.jvca.2019.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Indexed: 11/11/2022]
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7
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Fastenberg JH, Garzon‐Muvdi T, Hsue V, Reilly EK, Jabbour P, Rabinowitz MR, Rosen MR, Evans JJ, Nyquist GN, Farrell CJ. Adenosine‐induced transient hypotension for carotid artery injury during endoscopic skull‐base surgery: case report and review of the literature. Int Forum Allergy Rhinol 2019; 9:1023-1029. [DOI: 10.1002/alr.22381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/28/2019] [Accepted: 06/20/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Judd H. Fastenberg
- Department of Otolaryngology–Head & Neck SurgeryThomas Jefferson University Hospitals Philadelphia PA
| | - Tomas Garzon‐Muvdi
- Department of Neurosurgery and Neurological SciencesThomas Jefferson University Hospitals Philadelphia PA
| | | | - Erin K. Reilly
- Department of Otolaryngology–Head & Neck SurgeryThomas Jefferson University Hospitals Philadelphia PA
| | - Pascal Jabbour
- Department of Neurosurgery and Neurological SciencesThomas Jefferson University Hospitals Philadelphia PA
| | - Mindy R. Rabinowitz
- Department of Otolaryngology–Head & Neck SurgeryThomas Jefferson University Hospitals Philadelphia PA
| | - Marc R. Rosen
- Department of Otolaryngology–Head & Neck SurgeryThomas Jefferson University Hospitals Philadelphia PA
| | - James J. Evans
- Department of Neurosurgery and Neurological SciencesThomas Jefferson University Hospitals Philadelphia PA
| | - Gurston N. Nyquist
- Department of Otolaryngology–Head & Neck SurgeryThomas Jefferson University Hospitals Philadelphia PA
| | - Christopher J. Farrell
- Department of Neurosurgery and Neurological SciencesThomas Jefferson University Hospitals Philadelphia PA
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Patel PA, Gutsche JT, Augoustides JG. Cerebral Embolic Protection in Ascending Aortic Stenting-An Emerging Neuroprotective Paradigm. Semin Thorac Cardiovasc Surg 2018; 31:222-223. [PMID: 30366111 DOI: 10.1053/j.semtcvs.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Bokoch MP, Hiramoto JS, Lobo EP, Shalabi A. Rapid Ventricular Pacing for Landing Zone Precision During Thoracic Endovascular Aortic Arch Repair: A Case Series. J Cardiothorac Vasc Anesth 2017; 31:2141-2146. [DOI: 10.1053/j.jvca.2017.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 11/11/2022]
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10
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Fabbro M, Goldhammer J, Augoustides JGT, Patel PA, Frogel J, Ianchulev S, Cobey FC. CASE 1-2016 Problem-Solving in Transcatheter Aortic Valve Replacement: Cardiovascular Collapse, Myocardial Stunning, and Mitral Regurgitation. J Cardiothorac Vasc Anesth 2015; 30:229-36. [PMID: 26119409 DOI: 10.1053/j.jvca.2015.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Fabbro
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordan Goldhammer
- Cardiothoracic and Vascular Section, Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan Ianchulev
- Cardiac Section, Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Frederic C Cobey
- Cardiac Section, Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
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Gutsche JT, Ghadimi K, Patel PA, Robinson AR, Lane BJ, Szeto WY, Augoustides JG. New Frontiers in Aortic Therapy: Focus on Deep Hypothermic Circulatory Arrest. J Cardiothorac Vasc Anesth 2014; 28:1159-63. [DOI: 10.1053/j.jvca.2014.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Indexed: 01/03/2023]
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