Blood Pressure Monitoring Device for EVAR Surgery
Direct arterial pressure transduction via the femoral artery introducer sheath is the recommended method for blood pressure monitoring during endovascular aneurysm repair. 1
Standard Arterial Pressure Monitoring
The femoral artery introducer sheath should be used for direct arterial pressure transduction during EVAR procedures. 1 This approach is easily implemented since the sheath is already in place for the endovascular procedure itself.
Intravascular pressures may also be monitored from the coaxial (guiding) catheter or via the superselective catheter as alternative or supplementary monitoring sites. 1
Direct arterial pressure monitoring is particularly critical when manipulating systemic pressure with vasoactive agents during the procedure. 1
Additional Monitoring Requirements
Beyond arterial pressure monitoring, comprehensive hemodynamic surveillance during EVAR includes:
Continuous monitoring of blood flow to the patient via ultrasonic measurement on the arterial line is mandatory. 1
Pressure monitoring devices must be used on both the arterial line (pre- and post-oxygenator) and cardioplegia delivery systems. 1 While this recommendation originates from cardiopulmonary bypass guidelines, the principle of multi-site pressure monitoring applies to complex vascular procedures.
Continuous monitoring of venous oxygen saturation (SvO2) and hematocrit levels is recommended during complex procedures. 1
Supplementary Monitoring Considerations
An additional pulse oximeter placed on the foot of the leg receiving the femoral introducer catheter serves as an early warning system for femoral artery obstruction, distal thromboembolism, or overly vigorous compression during post-procedure hemostasis. 1
Bladder catheters assist in fluid management and patient comfort during longer procedures. 1
Specialized Pressure Monitoring Technology
While not standard practice, emerging technology exists for aneurysm sac pressure monitoring:
Implantable wireless pressure sensors can be placed within the aneurysm sac to directly measure intrasac pressure during and after EVAR. 2, 3, 4 These devices provide real-time confirmation of successful aneurysm exclusion and can detect type I or III endoleaks with 94% sensitivity and 80% specificity. 4
Successful EVAR typically results in an intraoperative decrease in pulse pressure and pulse pressure ratio of approximately 70-76% compared to baseline. 5, 4
These specialized sensors are not routinely used but may provide valuable ancillary information for confirming technical success intraoperatively and during follow-up surveillance. 5
Clinical Pitfalls to Avoid
Do not rely solely on non-invasive blood pressure monitoring during EVAR. The ability to manipulate hemodynamics with vasoactive agents requires beat-to-beat arterial pressure data that only invasive monitoring can provide. 1
Ensure the arterial line transducer is properly zeroed and positioned at the level of the phlebostatic axis to avoid measurement errors that could lead to inappropriate hemodynamic interventions.
Monitor for dampened arterial waveforms that may indicate catheter malposition, air bubbles in the system, or thrombus formation on the catheter tip.