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Perioperative Hemodynamic Management and Pharmacotherapeutics of Patients Undergoing Thoracic Endovascular Aortic Repair

DOI: 10.1155/2014/586084

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Abstract:

Thoracic endovascular aortic repair (TEVAR) has become an attractive alternative treatment option for many patients with specific thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications and improve neurological outcomes. Hemodynamic management of these patients is a critical aspect in reducing neurological deficit and it is different compared to patients undergoing open thoracic aortic operations. There are two different phases of blood pressure management for patients with thoracic aortic disease. Before and during the critical steps of TEVAR anti-impulsive therapy facilitates safe positioning and stent deployment. After stent grafts are deployed, controlled hypertensive blood pressure levels are achieved to avoid spinal cord ischemia. This precise blood pressure strategy is essential to ensure a safe procedure and good long-term results. 1. Introduction Since 1991, Parodi et al. described the first endovascular exclusion of an abdominal aortic aneurysm [1]; the technique and devices evolved rapidly and thoracic aortic diseases were involved. Dake et al. introduced in 1994 the use of stent grafts for the treatment of the descending thoracic aortic aneurysm for high risk patients [2] and Shimono et al. in 1998 for an acute type A aortic dissection [3]. Since the first stent grafts for thoracic endovascular aortic repair (TEVAR) were approved and become commercially available in 2005, feasibility and successful utilization of this technique have been established. Endovascular repair in selected patients with complex aortic pathologies has now lower perioperative mortality and complications compared with open surgical repair [4–6]. Besides the interventional treatment, in patients with thoracic aortic disease stringent antihypertensive therapy, lipid profile optimization, smoking cessation, and reduction of other atherosclerosis risk factors are recommended [7]. This accompanying medical therapy has evolved and their benefits were studied on the effect of aneurysm growth. Furthermore, blood pressure management plays a critical role during the TEVAR procedure itself and demands a close collaboration between the surgeon and anesthesiologist as well as an understanding of each specialty and interventional steps. The aim of this is to provide a concise update on various aspects of thoracic endografting followed by a more comprehensive review of the antihypertensive medications used for hemodynamic management of the patients with aortic disease and during the endovascular procedure. 2. Preoperative

References

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