Abstract
Thoracic endovascular aortic repair (TEVAR) has become an attractive alternative treatment option for many patients with specific thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications and improve neurological outcomes. Hemodynamic management of these patients is a critical aspect in reducing neurological deficit and it is different compared to patients undergoing open thoracic aortic operations. There are two different phases of blood pressure management for patients with thoracic aortic disease. Before and during the critical steps of TEVAR anti-impulsive therapy facilitates safe positioning and stent deployment. After stent grafts are deployed, controlled hypertensive blood pressure levels are achieved to avoid spinal cord ischemia. This precise blood pressure strategy is essential to ensure a safe procedure and good long-term results.
Highlights
Since 1991, Parodi et al described the first endovascular exclusion of an abdominal aortic aneurysm [1]; the technique and devices evolved rapidly and thoracic aortic diseases were involved
Dake et al introduced in 1994 the use of stent grafts for the treatment of the descending thoracic aortic aneurysm for high risk patients [2] and Shimono et al in 1998 for an acute type A aortic dissection [3]
In patients with aortic aneurysms that require fixation or landing zones within the aortic arch, endovascular repair requires either a hybrid two-staged operation with open surgical debranching followed by endovascular graft exclusion or a single stage endovascular repair using either branched or fenestrated stent grafts
Summary
Since 1991, Parodi et al described the first endovascular exclusion of an abdominal aortic aneurysm [1]; the technique and devices evolved rapidly and thoracic aortic diseases were involved. In patients with thoracic aortic disease stringent antihypertensive therapy, lipid profile optimization, smoking cessation, and reduction of other atherosclerosis risk factors are recommended [7] This accompanying medical therapy has evolved and their benefits were studied on the effect of aneurysm growth. Blood pressure management plays a critical role during the TEVAR procedure itself and demands a close collaboration between the surgeon and anesthesiologist as well as an understanding of each specialty and interventional steps The aim of this is to provide a concise update on various aspects of thoracic endografting followed by a more comprehensive review of the antihypertensive medications used for hemodynamic management of the patients with aortic disease and during the endovascular procedure
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