Anesteziologický pohled na chirurgickoua endovaskulární léčbu aneurysmat břišní aorty

An Anaesthesiological View of Surgical and Endovascular Repair of Abdominal Aortic Aneurysms

Objective:
To evaluate the effect of the anaesthesiological and surgical technique on morbidity and mortality in patientswith cardiac limitation sundergoing extensive procedure (repair of abdominal aorta aneurysm).Design: Clinical, retrospective study.Setting: Department of Anaesthesiology and Intensive Care, 1st Department of Surgery, Department of Radiology of PalackyUniversity Faculty Hospital and Medical Faculty, Olomouc.Material and Methods: During eight years period (1997–2003) 225 patients were treated for abdominal aorta aneurysm. 115patients underwent standard surgery (SUR group), 110 patients were treated with endovascular method (EVT group). Fromcase histories and anaesthesiological records, demographic and perioperative data were recorded. They comprised thetype and duration of anaesthesia, haemodynamic parameters (blood pressure, puls rate) and number of blood unitstransfused. Relevant statistical tests were used to compare the SUR and EVT groups; P < 0.05 was considered significant.Results: The groups did not differ in body weight, procedure duration and sex distribution. EVT group patients presentedhigher risk. The ASA IV grade being more frequent in this group (P < 0.0001). The SUR group included more ASA II gradepatients (P = 0.004). Patients in the EVT group were older (P = 0.018), more often they suffered from ischaemic heart disease(P = 0.0002) and more often underwent myocardial infarction (P < 0.0001) and CABG surgery (P = 0.028). Incidence ofdiabetes mellitus was higher in the EVT group (P = 0.0007). Surgical treatment (SUR group) was usually performed undergeneral anaesthesia (99.1%), while spinal block was preferably used for the EVT group patients (61%). SUR group patientsrequired haemotherapy more often compared to EVT group (P < 0.0001). There was better haemodynamic stability in theEVT group (P < 0.05). Both morbidity and mortality were significantly lower in the EVT group (P < 0.0001 and P = 0.0096,respectively) and intensive care stay was shorter (2 days) than in the SUR group (5 days). The total hospital stay was shorterin the EVT group (5 days) compared to SUR one (11 days).Conslusion: The high risk patients benefit from EVT, which can be a method of choice for them.

Key words:
abdominal aortic aneurysm – stent-graft – high risk patient