Perioperative Considerations and Anesthetic Management for Endovascular Procedures

摘要

Since the author's previous reviews of this topic in 1999 and 2002 there have been very few general reviews . The history of endovascular surgery goes back to 1864, but in the modern era stents and stent-grafts have become popular and have become the standard of care only in the last 10-15 years [1,2,4]. The technology of the delivery systems and the stents or stent-grafts continues to improve which: allows for speedier deployment; reduces the size of the endovascular delivery equipment thereby limiting the damage to access arteries; allows for multiple fenestrations or branches in the grafts, such as for renal or other arteries off the aorta; and allows more flexible stents to be introduced into anatomic areas where there is a greater range of movement, such as the inguinal and popliteal regions.The advantages of endoluminal vascular surgery for the patient are: a shorter hospital stay (possibly one day only); quick return to normal activity and work; decreased reperfusion injury of the occluded delivery or run-off arteries; decreased generalized stress response; much less tissue trauma than with an open surgical wound; and fewer associated medical complications, such as myocardial infarction and pneumonia. The long-term surgical outcomes of these surgical procedures are still somewhat questionable because of the short time frame since their introduction and the rapidly changing technology. The improving technology will hopefully minimize longer-term problems of displacement, migration, or distortion of the stents or stent-grafts.