Endovascular aortic repair is associated with lower rates of cardiac, respiratory, and renal complications, including approximately half the risk for acute kidney injury compared to open repair.
Does endovascular aortic repair reduce perioperative complications compared to open aortic repair in vascular surgery patients?
Endovascular aortic repair significantly reduces the risk of major perioperative complications compared to open repair, highlighting the need for tailored postoperative intensive care management.
Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved in recent years, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy. The intensive care physician must be aware that aortic repair surgery has an impact on every organ system, and the importance of early recognition of organ failure cannot be overemphasized.
Paulis et al. (2022) conducted a review in Aortic repair. Endovascular aortic repair (EVAR) vs. Open aortic repair was evaluated. Endovascular aortic repair is associated with lower rates of cardiac, respiratory, and renal complications, including approximately half the risk for acute kidney injury compared to open repair.