Thoracoabdominal aneurysm repair: a case report

Abstract

Aneurysms that extend from the descending thoracic aorta into the abdomen, which can also involve the visceral segments of the upper abdominal aorta, are traditionally classified as thoracoabdominal. Thoracoabdominal aortic aneurysm reconstruction is very complex vascular surgery associated with high postoperative morbidity and mortality and related postoperative complications. In addition to the surgical complexity associated with repair of these aneurysms, the temporary interruption of blood flow distal to the clamp introduces multiple considerations for the anesthetic practitioner to consider for the reduction of potential complications. This case report involves an 80-year-old female presenting for elective repair of a type IV thoracoabdominal aortic aneurysm, with utilization of standard invasive hemodynamic monitoring and cerebrospinal perfusion pressure monitoring as a neuroprotective measure. Hemodynamic stability was maintained via vasoactive agents, as well as compensatory vascular repletion guided by invasive monitoring. A definitive anesthetic plan based on thorough preoperative assessment, insistent intraoperative management techniques to minimize potential complications, and postoperative management of this patient allowed for successful vascular reconstruction, resulting in a positive patient outcome.