Temporary Surgical Arterial Closure Technique with Tourniquet Allows Transfemoral Endovascular Repair of Aortic Aneurysm in Local Anaesthesia

Introduction aorta, the graft is deployed and the delivery system removed. The arteriotomy is temporarily controlled Since the introduction of the endovascular repair of with two running sutures, beginning at each end of arteriotomy and secured in the midline with a abdominal aortic aneurysms the technique has become popular but the long-term effectiveness is tourniquet (Fig. 1). Blood flow through the femoral artery is allowed to resume, and only the guidewire unknown. More than half of patients with an infrarenal aortic aneurysm can be treated by enremains in place. For a bifurcated prosthesis the introduction of the contralateral leg of the prosthesis dovascular techniques. Transfemoral endovascular aortic aneurysm repair currently requires at least one is performed simultaneously from the other femoral artery. The suture line is completed at the end of the femoral arteriotomy. This procedure is usually performed under general anaesthesia probably because procedure. of the long clamping time necessary for placement and fixation of endoprosthesis. The femoral arteriotomy is Results closed only after the device is sealed and a long clamping time can induce a variable degree of ischWe performed a transfemoral endovascular repair of aemia and reperfusion injury. We propose a technical an abdominal aortic aneurysm in 17 patients; in nine modification which allows for antegrade flow in the with the standard and eight with the new technique femoral artery during placement of endovascular prosincluding 15 bifurcated and two straight endovascular thesis, therefore enabling the procedure to be perVanguard prosthesis (one with standard and one formed under local anaesthesia. with new technique). The first seven patients were treated under general anaesthesia and the others under local anaesthesia. Surgical access was on the right Technique femoral artery in 16 patients and the left one in one. There was no delivery problem. With the new techUnder local anaesthesia (lidocain 0.5–1%, 5 mg/kg of nique, the clamping time of femoral artery was reduced body weight, without adrenaline) the right femoral from 66±14 min using the old technique to 21±5 min. artery is exposed through a vertical incision below the Mean intervention time was 120±30 min (n=17) and inguinal ligament. The artery is secured proximally there was no difference between both groups; 8/10 and distally with tourniquets and a transverse incision patients operated under local anaesthesia were sent is performed above the femoral bifurcation. The ento the regular station after short observation time (2 h) dovascular delivery system is introduced into the on the intermediate care station. Only 2/10 were sent to the intensive care unit because the operation ended ∗ Please address all correspondence to: M. Lachat, Dept. of Cardioafter the unit closed (5.30 p.m.). Seven patients opvascular Surgery, University Hospital Zurich, Ramistrasse 100, 80981 Zurich, Switzerland. erated under general anaesthesia were extubated soon