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Dada RS, Kakuturu J, Cook C, Toker A, Ellison M. Descending Thoracic Aorta Replacement in the Setting of Coexisting Aortobronchial and Aortoesophageal Fistula Formation After Open Thoracic Aortic Graft Placement and Subsequent Endovascular Aortic Repair. J Cardiothorac Vasc Anesth 2024; 38:499-504. [PMID: 38071146 DOI: 10.1053/j.jvca.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/15/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Rachel S Dada
- Department of Anesthesiology, West Virginia University, Morgantown, WV.
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Chris Cook
- Division of Cardiothoracic Surgery, Sentara Heart Hospital, Norfolk, VA
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Matthew Ellison
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, Morgantown, WV
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Agarwal S, Kendall J, Quarterman C. Perioperative management of thoracic and thoracoabdominal aneurysms. BJA Educ 2019; 19:119-125. [PMID: 33456880 DOI: 10.1016/j.bjae.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- S Agarwal
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Kendall
- Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
| | - C Quarterman
- Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
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Abstract
A review of the literature on the management of thoracic aneurysm is presented. These patients have various comorbid conditions and need thorough work-ups. Aneurysms can be classified according to shapes and locations. Various methods to maintain hemodynamic stability with adequate endorgan perfusion are presented. The success of the operation depends upon preoperative anticipation and preparation for adequate organ perfusion and hemodynamic stability along with good communication between the anesthesiologist and the surgical team.
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Abstract
The conduct of partial left heart bypass or partial car diopulmonary bypass (CPB) during surgery involving the descending thoracic aorta or thoracoabdominal aorta is one of the most unappreciated and misunder stood extracorporeal circulation procedures in cardio vascular surgery. It is different from conventional CPB, and although some uninitiated practitioners consider it simpler, it is in fact more complicated than conven tional CPB and involves different concepts. It requires expertise and skill in regulating the flow, pressure, and oxygenation of blood going to both the proximal and distal parts of the body and management of the special bypass or shunt procedures used, specialized monitor ing, and knowledge about the protection and preserva tion of organs both proximal and distal to the aortic clamping. It demands exquisite communication and un derstanding of the unique problems faced by the sur geon, anesthesiologist, and perfusionist.
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Affiliation(s)
- Eugene A. Hessel
- Department of Anesthesiology, College of Medicine, Chandler Medical Center, University of Kentucky, Louisville, KY
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The Effect of Perioperative Ischemia and Reperfusion on Multiorgan Dysfunction following Abdominal Aortic Aneurysm Repair. BIOMED RESEARCH INTERNATIONAL 2015; 2015:598980. [PMID: 26798637 PMCID: PMC4698535 DOI: 10.1155/2015/598980] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/30/2015] [Accepted: 09/07/2015] [Indexed: 12/03/2022]
Abstract
Abdominal aortic aneurysms (AAAs) are relatively common and are potentially life-threatening medical problems. The aim of this review is to provide an overview of the effect of I/R injury on multiorgan failure following AAA repair. The PubMed, CINAHL, EMBASE, Medline, Cochrane Review, and Scopus databases were comprehensively searched for articles concerning the pathophysiology of I/R and its systemic effects. Cross-referencing was performed using the bibliographies from the articles obtained. Articles retrieved were restricted to those published in English. One of the most prominent characteristics of AAA open repair is the double physiological phenomenon of ischemia-reperfusion (I/R) that happens either at the time of clamping or following the aortic clamp removal. Ischemia-reperfusion injury causes significant pathophysiological disturbances to distant organs, increasing the possibility for postoperative multiorgan failure. Although tissue injury is mediated by diverse mechanisms, microvascular dysfunction seems to be the final outcome of I/R.
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Anwar MO, Aydin A. The significance of the pelvic collateral circulation in aorto-iliac disease. Clin Anat 2015; 28:558-9. [PMID: 25716543 DOI: 10.1002/ca.22518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/24/2014] [Accepted: 01/18/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Mohammed Omer Anwar
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, United Kingdom
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Goodwin MR, Blasius KR, Brand J, Silvay G. One-lung ventilation for surgical repair of thoracic aortic aneurysm. Semin Cardiothorac Vasc Anesth 2013; 17:146-51. [PMID: 23615328 DOI: 10.1177/1089253213485642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in the surgical approach to thoracic aortic aneurysm repairs have led to the increasing use of one-lung ventilation. Today's practice of cardiothoracic and vascular anesthesia requires a clear understanding of the techniques available for lung separation and the technical skills necessary to employ them. In this article, we discuss and evaluate the options for one-lung ventilation in thoracic aortic aneurysm repair with regard to preoperative, intraoperative, and postoperative management.
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Nguyen L, Banks D, Madani M, Bulatao J. CASE 6—2009 Anesthetic Implications of Partial Left-Heart Bypass for Repair of the Descending Thoracic Aorta. J Cardiothorac Vasc Anesth 2009; 23:893-900. [DOI: 10.1053/j.jvca.2009.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Indexed: 11/11/2022]
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Knapp J, Bernhard M, Rauch H, Hyhlik-Dürr A, Böckler D, Walther A. [Anesthesiologic procedure for elective aortic surgery]. Anaesthesist 2009; 58:1161-82. [PMID: 19907924 DOI: 10.1007/s00101-009-1630-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aortic aneurysms are frequent in the elderly who often suffer from relevant co-morbidities. In Germany it is estimated that approximately 250,000 patients suffer from an aortic aneurysm. Due to the high risk of cardiac or pulmonary complications operative management poses a challenge to the anesthesiologist. Especially hemodynamic management during aortic cross-clamping requires anesthesiologic know-how and an anticipatory use of vasodilators and catecholamines. Furthermore, the anesthesiologist has to protect renal function. In order to avoid paraplegia due to spinal ischemia cerebrospinal fluid drainage may be necessary in patients with aneurysms of the thoracic aorta. In recent years endovascular repair of aortic aneurysms has been established in addition to conventional open surgery. As a consequence in some patients aortic surgery can be performed under regional or local anesthesia. In special cases thoracic endovascular repair requires a medicinal induction of heart arrest or the reduction of aortic blood flow by overpacing.
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Affiliation(s)
- J Knapp
- Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
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Naik B, Lobato EB, Martin TD, Willert J, Janelle GM, Urdaneta F. Use of cerebrospinal fluid drainage catheters during single-stage transmediastinal repair of ascending/descending aortic aneurysms. J Cardiothorac Vasc Anesth 2004; 18:624-7. [PMID: 15578475 DOI: 10.1053/j.jvca.2004.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bhiken Naik
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
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Hofland J, Tenbrinck R, Eggermont AMM, Eijck CHJ, Gommers D, Erdmann W. Effects of simultaneous aortocaval occlusion on oxygen consumption in patients. Clin Physiol Funct Imaging 2003; 23:275-81. [PMID: 12950325 DOI: 10.1046/j.1475-097x.2003.00510.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The effects of simultaneous occlusion of the thoracic aorta and inferior vena cava on oxygen consumption (V O 2) have not yet been reported in humans. Ten patients (all ASA II) needed such simultaneous occlusion to allow hypoxic abdominal perfusion in the treatment of pancreatic cancer. With the development of the PhysioFlex anaesthesia machine for closed-circuit anaesthesia, intra-operative real-time curves of V O 2 became available. Thus, we can continuously measure F I O 2, V E, V O 2, and air consumption. By placing a pulmonary artery catheter, we could also intermittently calculate D O 2 during the several phases of the perfusion procedure. Immediately after the simultaneous aortocaval occlusion started, V O 2 decreased by 35% (68 ml min-1 m-2) and D O 2 decreased below the critical value of 330 ml min-1 m-2. At reperfusion, repayment of the oxygen debt was by a two-stage pattern: a fast repayment stage with an increase of about 65% was followed by a slow repayment stage of 14% increase (values compared to steady state). Oxygen consumption in women was found to be significantly lower than in men (P = 0.02), with significant variation between the sexes during different stages of the procedure. The oxygen debt was not completely repaid by the end of the procedure. We conclude that the significant variation found in oxygen consumption will have consequences while performing low-flow anaesthesia, that additional oxygen supply during the recovery period because of the initially incomplete repayment of oxygen debt may be useful and that studies on oxygen consumption must present gender-specific data because of the gender-dependent variation found in oxygen consumption.
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Affiliation(s)
- Jan Hofland
- Departments of Anaesthesiology and Surgical Oncology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Fayad A, Sawchuk C, Yang H, Cina C. Transesophageal echocardiography in the management of left atrio-femoral bypass during thoracoabdominal aortic aneurysm repair: a case report. Can J Anaesth 2002; 49:1081-3. [PMID: 12477683 DOI: 10.1007/bf03017907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe the utility of transesophageal echocardiography (TEE) in a patient undergoing thoracoabdominal aneurysm (TAA) surgery using left atrio-femoral bypass (LAFB). CLINICAL FEATURES A 57-yr-old female patient underwent repair of type II TAA. As per institutional routine, LAFB technique was used. Initial difficulty with the pump flow was encountered. TEE images showed that the left atrial cannula was positioned against the left atrial wall. The cannula position was adjusted and the pump flow was established. During different stages of the surgery, TEE was used to monitor the left ventricular cavity size and its function. This allowed the adjustment of LAFB pump flow relative to left ventricular filling and optimal fluid resuscitation in order to maintain both upper and lower body perfusion. CONCLUSION In this patient, TEE was useful to confirm the correct position of the left atrial cannula and for hemodynamic management during LAFB.
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Affiliation(s)
- Ashraf Fayad
- Department of Anesthesia, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
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Anagnostopoulos PV, Shepard AD, Pipinos II, Nypaver TJ, Cho JS, Reddy DJ. Factors affecting outcome in proximal abdominal aortic aneurysm repair. Ann Vasc Surg 2001; 15:511-9. [PMID: 11665433 DOI: 10.1007/s10016-001-0030-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Sixty-five consecutive patients undergoing nonemergent repair of an abdominal aortic aneurysm (AAA) originating above the visceral and/or renal arteries were studied to determine operative results and identify factors influencing outcome of proximal AAA repair. Factors associated with postoperative morbidity were analyzed using multivariate analysis. There were no postoperative deaths, paraplegia/paraparesis, or symptomatic visceral ischemia. Proximal AAA repair can be accomplished with acceptable mortality. If renal artery bypass or reimplantation is anticipated, cold renal perfusion may protect against renal dysfunction. Postoperative pulmonary dysfunction can be reduced by avoiding radial division of the diaphragm.
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Affiliation(s)
- P V Anagnostopoulos
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
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