Clinical scenario
Treatment of Ruptured Abdominal Aortic Aneurysm with Anatomy Suitable for Endovascular Repair
In patients presenting with ruptured abdominal aortic aneurysm (AAA), the choice of repair strategy and the perioperative approach are critical determinants of outcome. When aortic anatomy is suitable for endovascular repair, this anatomical characteristic directly shapes both the recommended intervention and the hemodynamic management strategy.
Clinical situation
This protocol applies to patients with ruptured AAA whose aortic anatomy is confirmed to be suitable for endovascular repair. In this setting, endovascular repair is recommended over open repair to reduce the risk of morbidity and mortality.
Treatment approach
Management involves a permissive approach to hemodynamics aimed at limiting ongoing hemorrhage, combined with endovascular repair of the aorta. Specific anesthetic considerations play a key role in guiding procedural setup and perioperative outcomes. The complete hemodynamic targets, procedural sequence, and anesthetic protocol are detailed in the full structured regimen.
References
DOI: 10.1161/CIR.0000000000001106
In patients presenting with ruptured AAA who have suitable anatomy, endovascular repair is recommended over open repair to reduce the risk of morbidity and mortality.
In patients undergoing endovascular repair for ruptured AAA, local anesthesia is preferred to general anesthesia to reduce risk of perioperative mortality.
In patients with ruptured AAA, permissive hypotension can be beneficial to decrease the rate of bleeding.
An SBP that allows a patient to maintain mentation, typically between 60 and 90 mm Hg, is suggested.
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