Uğur GÖÇEN, Atakan ATALAY

Are type B aortic dissections feasible to intervention under local anesthesia?

Amaç: Tip B Aort diseksiyonlarında endovasküler girişim sıklıkla genel anestezi veya sedasyon ile yapılmaktadır. Anestezi kaynaklı gelişebilecek komplikasyonlardan korunmak ve bilişsel faailiyetleri gözlemek için biz inguinal lokal anestezi uygulayarak endovasküler stent greft ile tedavi yaptığımız Tip B aort diseksiyonu hastalarında tecrübemizi paylaşmayı amaçladık. Gereç ve Yöntem: Mart 2010 ile Şubat 2015, arasında kliniğimizde Tip B aort diseksiyonlu 23 hastada inguinal lokal anestezi ile femoral arter girişimi ile endovasküler stent greft tamiri uyguladık. Kooperasyonları iyi olan, nörolojik problemi olmayan ve hemodinamik olarak stabil (sistolik tansiyon 90-120 mmHg ve diastolik tansiyon 5070 mmHg) hastalar çalışmaya dahil edildi. Hastalar postoperatif üçüncü ve altıncı aylarda kontrol amaçlı BT angiografi ile değerlendirildi. Bulgular: Acil Tip B diseksiyonu nedeniyle torasik endovasküler stent implante edilen 4 hastadan birinde sol kalp yetersizliği, pulmoner ödem ve viseral iskemi, bir tanesinde inatçı hipertansiyon, sırt ağrısı ve radyolojik olarak gelişmekte olan rüptür bulguları ve diğer ikisinde renal malperfüzyon ve anüri mevcuttu. Diğer elektif 19 hastada sırt ağrısı ve hipertansiyon dışında bulgu yoktu. Tüm hastalarda torasik stent greft ile tamir işlemi başarılı bir biçimde uygulandı. Hastane mortalitesi acil uygulama yapılan 1 hastada multiorgan yetmezliği nedeniyle görüldü. Yaşayan hiçbir hastada nörolojik defisit görülmedi. Sonuç: Endovasküler stent greft uygulanması Tip B aort diseksiyonlarında acil durumlarda bile genel anestezi ve sedasyon uygulanmadan lokal anestezi ile femoral arter girişimi kullanılarak başarılı bir şekilde uygulanabilir

Tip B aort diseksiyonları lokal anestezik girişim ile tedavi edilebilirmi?

Purpose: In Type B Arotic diseections, endovascular interventions are frequently performed under sedation or general anesthesia. To prevention of complications that can occur due to anesthesia and to observe cognitive activities, we share our experience with endovascular stent graft performed under inguinal local anesthesia in patients with Type B aortic dissection. Material and Methods: Between March 2010 and March 2016, we performed endovascular stent graft repair with inguinal local anesthesia for 23 Type B aortic dissection patients in our clinic. Only patients with good cooperation, hemodynamically stable (Systolic 120-90 mmHg and Diastolic 70-50mmHg) were included in to study. A follow up CT angiography at postoperative months 3 and 6 were performed for patient assessment. Results: Of 4 patients who had an implantation of thoracic endovascular stent due to emergency Type B aortic dissection, one had left heart failure, pulmonary edema, and visceral ischemia, one had persistent hypertension, back pain, and two others had renal malperfusion and anuria. In the remaining 19 elective cases, no signs or symptoms other than hypertension and back pain were present. Stent graft procedure could be accomplished successfully in the appropriate anatomical location in all patients. There was one in-patient mortality due to multi-organ failure in a patient who underwent emergency intervention. No neurological deficits occurred in any of the surviving patients. Conclusions: Endovascular stent graft may be successfully accomplished through the femoral artery without general anesthesia and sedation in patients with Type B aortic dissections, even in the emergency setting

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