Review Article

Anesthetic considerations for endovascular repair of ruptured abdominal aortic aneurysms

KH Kevin Luk* and Koichiro Nandate

Published: 11 September, 2018 | Volume 2 - Issue 1 | Pages: 014-019

Ruptured abdominal aortic aneurysm (rAAA) carries high morbidity and mortality. Advances in endovascular techniques in the last two decades allow for minimally invasive approach for repair of these aneurysms. A succinct but comprehensive pre-operative is essential for delivery of a safe anesthetic for the patient with rAAA. Placement of proximal occlusion balloon in the descending aorta using the rapid control technique can be life-saving. Endovascular aortic repair (EVAR) can be performed under monitored anesthesia care using local anesthetic and IV sedation, and with fewer invasive lines. However, rapid conversion to general endotracheal anesthesia should be expected. Anesthesiologists should be familiar with the hemodynamic management of rAAA and be ready to provide resuscitation to correct for anemia, coagulopathy, and acidemia. In addition, the anesthesiologist should be aware of the common complications related to EVAR, including abdominal compartment syndrome, distal ischemia, and local vessel injury.

Read Full Article HTML DOI: 10.29328/journal.avm.1001005 Cite this Article Read Full Article PDF


  1. Ellard L, Djaiani G. Anesthesia for vascular emergencies. Anaesthesia. 2013; 68 (Suppl 1): 72-83. Ref.: https://goo.gl/4YV6tY
  2. Slater BJ, Harris EJ, Lee JT. Anatomic suitability of ruptured abdominal aortic aneurysms for endovascular repair. Ann Vasc Surg. 2008; 22: 716-722. Ref.: https://goo.gl/Gc85Rz
  3. Hoornweg LL, Wisselink W, Vahl A, Balm R; Amsterdam Acute Aneurysm Trial Collaborators. The Amsterdam acute aneurysm trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2007; 33: 679-683. Ref.: https://goo.gl/3XzHtz
  4. Bown MJ, Sutton AJ, Bell PR, Sayers RD. A meta-analysis of 50 years ruptured abdominal aortic aneurysm repair. Br J Surg. 2002; 89: 714-730. Ref.: https://goo.gl/FrBmiJ
  5. Mastracci TM, Garrido-Olivares L, Cina CS, Clase CM. Endovascular repair of ruptured abdominal aortic aneurysms: systemic review and meta-analysis. J Vasc Surg. 2008; 47: 214-221. Ref.: https://goo.gl/WPtYfh
  6. Phillipsen TE, Hendriks JM, Lauwers P, Voormolen M, d’Archambeau O, et al. The use of rapid endovascular balloon occlusion in unstable patients with ruptured abdominal aortic aneurysm. Innovation. 2009; 4: 74-79. Ref.: https://goo.gl/PV5Aew
  7. Raux M, Marzelle J, Kobeiter H, Dhonneur G, Allaire E, et al. Endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes. J Vasc Surg. 2015; 61: 304-308. Ref.: https://goo.gl/RgLjx5
  8. Montan C, Hammar U, Wikman A, Berlin E, Malmstedt, Holst J, et al. Massive blood transfusion in patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2016; 52: 593-603. Ref.: https://goo.gl/yiB3Gi
  9. Montan C, Joansson F, Hedin U, Wahlgren CM. Preoperative hypofibrinogenemia is associated with increased intraoperative bleeding ruptured abdominal aortic aneurysms. Thromb Res. 2014; 135: 443-448. Ref.: https://goo.gl/nN46u5
  10. Fransson M, Rydningen H, Henriksson AE. Early coagulopathy in patients with ruptured abdominal aortic aneurysm. Clin Appl Thromb Hemost. 2012; 18: 96-99. Ref.: https://goo.gl/akBujq
  11. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, et al. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma: The PROPPR Randomized Clinical Trial. JAMA. 2015; 313: 471–482. Ref.: https://goo.gl/94HL8s
  12. Hoste EA1, Colpaert K, Vanholder RC, Lameire NH, De Waele JJ. et al. Sodium bicarbonate versus THAM in ICU patients with mild metabolic acidosis. J Nephrol. 2005; 18: 303–307. Ref.: https://goo.gl/G7jEkN
  13. Edwards MS, Andrews JS, Edwards AF, Ghanami RJ, Corriere MA, et al. Results of endovascular aortic aneurysm repair with general, regional and local/monitored anesthesia care in the American College of Surgeons national Surgical Quality Improvement Program data-base. J Vasc Surgery. 2011; 54: 1273-1282. Ref.: https://goo.gl/85dgXN
  14. Walschot LH, Laheij RJ, Verbeek AL. Outcome after endovascular abdominal aortic aneurysm repair: meta-analysis. J Endovascular Ther. 2002; 9: 82-89. Ref.: https://goo.gl/vqUBWW
  15. Smith TA, Ramirez D. Awake, percutaneous repair of ruptured abdominal aortic aneurysm. Ochsner J. 2013; 13: 248-251. Ref.: https://goo.gl/XF4mGa
  16. Tay JW, Leong YP. Ruptured abdominal aortic aneurysm treated by endovascular aneurysm repair under local anesthesia. Md J Malaysia. 2012; 67: 111-112. Ref.:© https://goo.gl/qLH19S
  17. Brown BJ, Zakhary S, Rogers L, Ellis-Stoll C, Gable D, et al. Use of dexmedetomidine versus general anesthesia for endovascular repair of abdominal aortic aneurysms. Proc (Bayl Univ Cent). 2006; 19: 213-215. Ref.: https://goo.gl/jXjMws
  18. Maleux G, Koolen M, Heye S. Complications after endovascular aneurysm repair. Semin Intervent Radiol. 2009; 26: 3-9. Ref.: https://goo.gl/zsUdmK
  19. Shah SK, Parodi FE, Eagleton MJ, Bena JF, Clair DG. Iliac injury during abdominal and thoracic endovascular intervention. J Vasc Surg. 2016; 64: 726-730. Ref.: https://goo.gl/2FnLgN
  20. Rubenstein C, Bietz G, Davenport DL, Winkler M, Endean ED. Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2015; 61: 648-654. Ref.: https://goo.gl/F824pD


Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?