Are type B aortic dissections feasible to intervention under local anesthesia?

Abstract

Purpose: In Type B Arotic diseections, endovascular interventions are frequently performed under sedation or general anesthesia. To prevention of complications that can occur due to anesthesia and to observe cognitive activities, we share our experience with endovascular stent graft performed under inguinal local anesthesia in patients with Type B aortic dissection. Material and Methods: Between March 2010 and March 2016, we performed endovascular stent graft repair with inguinal local anesthesia for 23 Type B aortic dissection patients in our clinic. Only patients with good cooperation, no neurological conditions and hemodynamically stable (Systolic 120-90 mmHg and Diastolic 70-50mmHg) were included in to study. A follow up CT angiography at postoperative months 3 and 6 were performed for patient assessment. Results: Of 4 patients who had an implantation of thoracic endovascular stent due to emergency Type B aortic dissection, one had left heart failure, pulmonary edema, and visceral ischemia, one had persistent hypertension, back pain, and two others had renal malperfusion and anuria. In the remaining 19 elective cases, no signs or symptoms other than hypertension and back pain were present. Stent graft procedure could be accomplished successfully in the appropriate anatomical location in all patients. There was one in-patient mortality due to multi-organ failure in a patient who underwent emergency intervention. No neurological deficits occurred in any of the surviving patients. Conclusions: Endovascular stent graft may be successfully accomplished through the femoral artery without general anesthesia and sedation in patients with Type B aortic dissections, even in the emergency setting. [Cukurova Med J 2016; 41(4.000): 680-686]

Keywords

• Thoracic Endovascular Aortic Repair
• Tip B Aortic Dissection
• Local Anesthesia