Endovasküler Aort Cerrahisinde Anestezi
Synopsis
Endovascular aortic repair (EVAR) offers a minimally invasive alternative to conventional open surgery in the treatment of abdominal aortic aneurysms, providing reduced hemodynamic stress, decreased blood loss, lower morbidity, and shorter hospital stays. However, it carries disadvantages such as high cost, graft rupture, endoleak, migration, thrombosis, and systemic complication risks originating from renal or ischemic issues. Since most candidate patients present with significant comorbidities including smoking history, hypertension, coronary artery disease, diabetes, COPD, and renal insufficiency, preoperative patient optimization must be achieved through detailed evaluation, cardiac consultation, and pulmonary function tests. Intraoperatively, general, regional, or local anesthesia may be chosen. General anesthesia provides safety regarding airway control and potential conversion to emergency open surgery, whereas regional and local anesthesia reduce recovery times and intensive care unit requirements. Intraoperative management critically requires maintaining organ perfusion and normothermia, hemodynamic stability, heparinization at target ACT values (200–250 seconds), blood pressure titration, and preventing radiopaque contrast-induced nephropathy. Postoperatively, patients should be monitored symptomatically for postimplantation syndrome—a sterile inflammatory response that typically resolves spontaneously within two weeks. In conclusion, EVAR is a delicate procedure requiring robust inter-team communication and multidisciplinary anesthetic management prepared for potential emergencies.
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