From the Guidelines
Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive procedure used to treat aortic diseases, offering reduced perioperative morbidity and mortality compared to open surgical repair 1.
Procedure
The procedure involves the use of a thoracic endovascular stent graft, which is housed in a large delivery system, requiring thorough review of the iliofemoral system to avoid access complications 2.
- Alternative access may be required in up to 21.1% of patients due to small or diseased access vessels 2.
- Percutaneous access for delivery of TEVAR has been performed safely and with a high degree of success, with technical success ranging from 94.4% to 98.9% 2.
Anesthesia Usage
The choice of anesthetic technique depends on the planned surgical interventions and the patient's comorbid conditions, with options including local, regional, or general anesthesia 3.
- Regional anesthetic techniques are not recommended in patients at risk of neuraxial hematoma formation due to thienopyridine antiplatelet therapy, low-molecular-weight heparins, or clinically significant anticoagulation 3.
- Retrospective studies indicate that patients having local versus regional or general anesthesia for endovascular stent grafts tend to have lower use of vasoactive agents and lower fluid requirements, shorter intensive care and hospital stays, earlier ambulation and gastrointestinal function, and lower incidence of respiratory and renal complications 3.
Patient Expectations
Patients undergoing TEVAR can expect a reduced hospital length of stay and better freedom from aneurysm-related mortality compared to open surgical repair 1.
- However, the survival advantage of TEVAR compared to open repair may disappear after 1-5 years, depending on the patient population and anatomy 1, 4.
Complication Interventions
Complications of TEVAR can include access vessel thrombosis, endoleak, and stent collapse, with reported rates of up to 5.2% and 2.5%, respectively 5.
- Coverage of the left subclavian artery, celiac artery, or both may be necessary to gain the necessary 2 cm of seal zone for successful endovascular repair, and has been associated with reasonable technical success and outcomes in single-institution series and clinical trials 4.
From the Research
Overview of Thoracic Endovascular Aortic Repair (TEVAR)
- TEVAR is a minimally invasive procedure used to treat thoracic aortic diseases, such as aneurysms and dissections 6, 7.
- The procedure involves the use of an endograft, which is inserted through a small incision in the groin and guided to the aortic lesion using imaging technology 7, 8.
Procedure and Anesthesia Usage
- TEVAR can be performed under general anesthesia (GA) or regional anesthesia (RA) 9, 10.
- The use of RA has been shown to be safe and effective, with benefits including reduced procedural time, operating room stay time, and mean rate of change in blood pressure 10.
- The choice of anesthesia depends on the patient's individual needs and the complexity of the procedure 9.
Patient Expectations
- Patients undergoing TEVAR can expect a shorter recovery time compared to open surgical repair 6, 8.
- However, patients should be aware of the potential risks and complications associated with the procedure, including stroke, spinal cord ischemia, device failure, and access site complications 6, 9.
Complication Interventions
- Complications such as spinal cord ischemia, peripheral vascular injury, contrast-induced nephropathy, postimplantation syndrome, and endoleaks can occur after TEVAR 6, 9.
- Early recognition and aggressive treatment of these complications are crucial to prevent long-term sequelae 9.
- The use of RA may provide additional benefits in terms of early recognition of neurologic complications 10.