Endovascular aortic repair

ENDOVASCULAR AORTIC REPAIR is a new alternative to conventional surgical repair of aortic pathology.1 This technique of aortic repair was first suggested by Dotter2 in 1969 and reached clinical application with the work of Parodi et al3 in 1990. Since this early work, the technology has been applied to the treatment of peripheral artery aneurysms,4,5 diffuse aortoiliac occlusive disease,6 aortic aneurysms and dissections, and traumatic aortic or arterial injuries.7 Endovascular grafts have the advantage of being a less-invasive technique compared with conventional arterial reconstructions, owing to the unique ability to insert these grafts through small incisions from remote arterial access sites. This minimally invasive approach results in several advantages to the patient compared with conventional aortic repair. Many patients undergoing aortic repair have concomitant cardiac, renal, and pulmonary disease, increasing the complexity of any anesthetic administered. Avoiding laparotomy or thoracotomy eliminates the need for extensive perioperative aortic dissection, which may be complicated by previous aortic surgery. This technique obviates the need for extensive and prolonged aortic occlusion, decreases blood loss, and avoids the significant fluid shifts that occur with visceral manipulation, lowering the risk of significant perioperative hemodynamic changes. Conventional open aortic repair required general anesthesia with or without supplemental regional anesthesia. Repair through the endovascular route is a less-invasive technique compared with an open reconstruction,8 requiring less anesthesia.