Endovascular Repair of the Abdominal Aortic Aneurysm

Since the early 1 990s, endovascular surgery has provided another treatment option for the management of abdominal aortic aneurysms. Its shorter postoperative recovery time, absence of an abdominal incision, and avoidance of aortic cross-clamping gives endovascular abdominal aortic aneurysm repair its appeal. New vascular grafts are being developed that may expand the number of eligible candidates. This less-invasive form of abdominal aortic aneurysm repair still provides the anesthesiologist with several challenges. The procedure has been performed under general anesthesia, regional anesthesia, and local anesthesia with monitored anesthesia care. The potential benefits of one anesthetic type over another for endovascular abdominal aortic aneurysm repair have not yet been fully explored. Several intraoperative complications, including acute aortic rupture and misdeployment of the stent graft, can necessitate conversion to an open laparotomy. Endovascular repair in the short term compares favorably to open surgical repair with a reduction in morbidity, blood loss, and hospital stay. Still, endovascular abdominal aortic aneurysm repair is a relatively new corrective modality, and long-term controlled trials comparing it with open repair have not yet been reported. As more research into the technique is performed, new strategies for endovascular abdominal aortic aneurysm repair may further increase the options available to patients.