Regional Anaesthesia versus General Anaesthesia in Endovascular Aneurysm Repair: The Surgical Nursing Interventions

Minimally invasive surgical techniques are a revolutionary and innovative approach to the practice of surgery. Endovascular aneurysm repair (EVAR) may offer a number of significant advantages in comparison with conventional open surgical repair. The purpose of this study was to compare regional anaesthesia (RA) and general anaesthesia (GA) in EVAR, and to describe the surgical nursing interventions. This included a retrospective analysis of 160 consecutive patients (age 55 to 96 years) who underwent EVAR under: epidural anaesthesia (EDA = 60 patients), combined spinal and epidural anaesthesia (Combined = 40 patients) and GA = 60 patients. Results were successful in all patients and no mortality was noticed. Among the GA group, 11 patients needed ICU support while only 5 from the other 2 groups. Furthermore, a statistically significant difference regarding median hospital stay was also noticed in favour of the regional group. In conclusion, RA is a safe and effective anaesthetic method for endovascular repair of abdominal aneurysms, offering several advantages including simplicity, haemodynamic stability, less need for ICU management and reduced hospital stay. The anaesthetic nurse can play a major role in the management of this anaesthesia throughout the procedure. © 2009, British Association of Anaesthetic and Recovery Nursing. All rights reserved

Cost and effectiveness comparison of endovascular aneurysm repair versus open surgical repair of abdominal aortic aneurysm: A single-center experience

The study objective was to compare the cost and effectiveness of two surgical techniques: open repair and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). We assessed 58 surgical operations of AAA repair conducted in 54 men and 4 women (aged 49-94 years) during 2003 and 2004. Open surgical repair was performed in 21 patients, and EVAR was performed in 37 patients. The evaluation of the effectiveness of both methods was based on the following factors: mortality within 30 days, surgery duration, total hospitalization time, and intensive care unit stay duration. The segmental costs of grafts, anesthesia, and extra materials were included in the calculations for the comparison of the costs of the two methods. A 30-day mortality of 5.17% and 0% was demonstrated for open surgical repair and EVAR, respectively. In regard to the operation's mean duration, this was calculated to 279.52 minutes for open repair and 193.57 minutes for EVAR. The mean duration of the in-hospital stay was 11.3 and 4.09 days for open repair and EVAR, respectively. Accordingly, the mean duration of intensive care unit stay was 2.81 and 0.23 days, respectively. The cost evaluation revealed a mean cost of 5374.3€ ($7,643.49) and 20,592.52€ ($29,287.50) for open repair and EVAR, respectively. Open repair is a "tested method" of its own time. EVAR seems to have the advantage on aspects of effectiveness, yet its major hallmark is its significant cost, as indicated in the relevant part of the current study. © 2008 Society for Vascular Nursing, Inc

Predicting the risk of rupture of abdominal aortic aneurysms by utilizing various geometrical parameters: revisiting the diameter criterion

The authors estimated noninvasively the wall stress distribution for actual abdominal aortic aneurysms (AAAs) in vivo on a patient-to-patient basis and correlated the peak wall stress (PWS) with various geometrical parameters. They studied 39 patients (37 men, mean age 73.7 +/- 8.2 years) with an intact AAA (mean diameter 6.3 +/- 1.7 cm) undergoing preoperative evaluation with spiral computed tomography (CT). Real 3-dimensional AAA geometry was obtained from image processing. Wall stress was determined by using a finite-element analysis. The aorta was considered isotropic with linear material properties and was loaded with a static pressure of 120.0 mm Hg. Various geometrical parameters were used to characterize the AAAs. PWS and each of the geometrical characteristics were correlated by use of Pearson's rank correlation coefficients. PWS varied from 10.2 to 65.8 N/cm2 (mean value 37.1 +/- 9.9 N/cm2). Among the geometrical parameters, the PWS was well correlated with the mean centerline curvature, the maximum centerline curvature, and the maximum centerline torsion of the AAAs. The correlation of PWS with maximum diameter was nonsignificant. Multiple regression analysis revealed that the mean centerline curvature of the AAA was the only significant predictor of PWS and subsequent rupture risk. This noninvasive computational approach showed that geometrical parameters other than the maximum diameter are better indicators of AAA rupture

The use of endoanchors in repair EVAR cases to improve proximal endograft fixation

Aim. The aim of this paper was to evaluate short-term outcome of the use of endoanchors to secure the primary migrated endograft and additional extender cuffs to the aortic wall in patients with previous failed endovascular aortic aneurysm repair. Methods. Consecutive patients who needed proximal repair of a primary failed endograft due to migration (with or without type IA endoleaks) were treated with endoanchors, with or without additional extender cuffs. Data of this group were prospectively gathered in vascular referral centers that were early adopters of the endoanchor technique. Preprocedural and periprocedural data were prospectively gathered and retrospectively analyzed. Follow-up after endoanchor placement consisted of regular hospital visits, with computed tomography or duplex scanning at 1, 6, and 12 months. Results. From July 2010 to May 2011, 11 patients (8 men), mean age 77 years (range, 59-88 years), were treated with endoanchors for a failed primary endograft (2 Excluder endografts, 1 AneuRx endograft, and 8 Talent endografts) due to distal migration of the main body, with or without type IA endoleak. Revision consisted of using endoanchors to secure the body of the primary endograft to the aortic wall to avoid persistent migration. Most patients had additional proximal extender cuffs with suprarenal fixation, which were secured with endoanchors to the aortic wall and in some patients also to the primary endograft. A median of 6 endoanchors were implanted. All endoanchors were positioned correctly but one. One endoanchor dislodged but was successfully retrieved using an endovascular snare. During a mean follow-up of 10 months (range, 3-18 months) no endoanchor-related complications or renewed migration of the endografts occurred. Two patients underwent repeat intervention due to persistent type IA endoleak during follow-up. Conclusion. The use of endoanchors to secure migrated endografts to the aortic wall is safe and feasible and might help to overcome persistent migration of primary failed endografts. In combination with the use of sole extender cuffs the majority of proximal EVAR failures can be solved