Die transfemorale endovaskuläre Behandlung thorakaler Aneurysmen in Lokalanästhesie: eine einfache, sichere und zeitsparende Technik

Abstract

Background: Endovascular aneurysm grafting of the descending thoracic aorta is a minimally invasive catheter technique, which is performed under general anesthesia. We describe a technique allowing to perform transfemoral endovascular repair of thoracic aortic repair under local anesthesia. Patients and methods: In 9 consecutive patients local anesthesia was performed in order to gain an opened femoral artery access for the delivery system, and a percutaneous access to the left brachial artery. A pigtail catheter was then placed through the left brachial artery for the location of the origin of the left subclavian artery and/or the aneurysm and self-expanding endoprothesis was released under fluoroscopic guidance. For the deployment of the endograft a short period of controlled hypotension with nitroglycerin bolus application was produced. Results: All the aneurysms could be successfully sealed with the intended endovascular technique. There was no vascular access complication or pulmonary or ischemic (cardiac, cerebral or peripheral) complication. In the follow-up period of 6 ± 3 months one patient needed a redo endovascular procedure because of the development of a severe and symptomatic distal endoleak 6 weeks postoperative. This procedure was again performed under local anesthesia. Conclusions: From a technical point of view, transfemoral endovascular repair of thoracic aneurysm can be performed under local anesthesia. This is a very simple and fast track procedure which combines a minimally invasive catheter technique and a less invasive anesthetic management.