British Journal of Anaesthesia, Vol 77, Issue 5 581-585, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
B. R. Baxendale, D. M. Baker, A. Hutchinson, T. A. Chuter, P. W. Wenham and B. R. Hopkinson
We have examined whether or not endovascular insertion of a bifurcated
aorto-iliac graft resulted in greater intraoperative haemodynamic and
metabolic stability than that achieved during conventional open graft
placement. We studied 20 patients prospectively during surgery for
asymptomatic infra-renal aortic aneurysm. All patients received the same
anaesthetic technique. Haemodynamic data were collected continuously using
indwelling radial artery and pulmonary artery catheters, allowing
calculation of mean arterial pressure (MAP), cardiac output (CO) and
systemic vascular resistance (SVR). Blood samples were obtained for
measurement of serum lactate concentrations. Variables were compared within
each group before and after specific critical events, namely occlusion of
femoral or aortic blood flow, or both, and sequential reperfusion of each
lower limb. Patients undergoing open repair showed significant changes in
CO, MAP and SVR related to aortic cross-clamping and lower limb
reperfusion, and a significant increase in blood lactate concentration
after distal tissue reperfusion. The only significant changes during
endovascular repair were a transient increase in SVR secondary to
application of the femoral artery clamps, and sequential decreases when
each limb was reperfused. Endovascular aneurysm repair imposed
significantly less intraoperative haemodynamic and metabolic stress on the
patient compared with conventional open surgery.
CLINICAL INVESTIGATIONS
Haemodynamic and metabolic response to endovascular repair of infra- renal aortic aneurysms
University Department of Anaesthesia, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH; Department of Vascular Surgery, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH; Department of Anaesthesia, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH; Division of Vascular Surgery, University of California, San Franciso, CA, USA
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