Epidural Anesthesia and Endovascular Repair of Abdominal Aortic Aneurysm Case Presenting With Severe Pulmonary Disease

Abstract

A 71 year old male presented to our emergency department with abdominal pain and nausea. Medical history consisted of chronic obstructive pulmonary disease, pneumonia, hypertension, previous history of smoking and tuberculosis, which was successfully treated. Physical examination was unremarkable except for rales in the right lung, prolonged expirium and arterial hypoxia (Peripheral oxygen saturation: 87–90% despite six l/min oygen therapy). Respiratory function tests showed severe obstruction (Forced expiratory volume in one second: 38%, forced expiratory volume in one second/forced vital capacity: 0.56). Computerised tomography revealed bilateral apical fibrotic sequels, traction bronchiectasis, peribronchovascular thickenings and emphysematous regions in the lungs, 40 mm wide ascending aorta with 13 mm wide patchy hypodense lesions, 58 mm wide aortic aneurysm located between the iliac artery and distal end of the superior mesenteric artery with 22 mm wide patchy hypodense regions (Fig. 1). These hypodense areas were initially thought of as thrombosis. As laboratory values were consistent with pneumonia (CRP: 25,3 mg/dl, WBC: 11.5 K/uL, sedimentation rate: 84), empirical antibiotherapy, oral and inhaler bronchodilator therapy, and prophylactic anticoagulant Introduction