tevar - anzsvn.org · post-op care • access sites • closure device vs cutdown ... • stroke...
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TEVARJune 2016
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TEVAR
• Thoracic Endovascular Aortic Repair
• Reasons• Aneurysm• Dissection (Acute Aortic Syndrome)• Trauma
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Aneurysm• Definition
• >50% diameter• Size important• Multifactorial causality
• More familiar AAA
• Thoracic• 35% descending aorta
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Acute Aortic Syndrome
• PAU
• IMH
• Dissection
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Acute Aortic Syndrome
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Trauma
• Transection• MVA• Blunt Trauma• Flaps
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Pre-op Care
• Dependent on indication• Trauma life-threatening surgical emergency
• Aneurysm• Preoperative work-up
» Cardiac/respiratory status» Size criteria» Adjunct procedures
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Pre-op Care
• Acute Aortic Syndrome– Emergency signs of malperfusion Theatre
– Medical management cornerstone» BP control (Systolic 110, HR 60)» Analgesia» Monitored environment» Serial imaging
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Procedure
• Principles– Proximal seal– Distal seal– Length of
Coverage– Covering of vessels– Need for
revascularisation
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Early Complications
• Access Site• Bleeding, Haematoma, retroperitoneal
• Treated segment• Further injury – dissection
• Peripheral• Emboli, ALI, Stroke
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Post-op Care• Access sites
• Closure Device vs Cutdown
• Neurovascular Obs• Limb ischaemia/emboli• Stroke• Neurology
• Pain
• Fever
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Closure Devices
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Spinal Drain
• Theory• CPP = MAP – ICP
• Able to manipulate • MAP
pharmacologically• ICP decreasing CSF
volume
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Spinal Drain• 2 ways to drain
• Pressure (10cm H2O)» Need steady readings hence lying flat
• Volume (10ml/hr)
• Placed by anaesthetic team• Issues – notify
• Complications• Traumatic tap• Epidural haematoma
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New Neurology• Notify team• O2• Lie flat• Assess drain to ensure able to drain
• Kinks in line
• Adjust MAP• Drain off more CSF• Reverse opioids• Vascular Status• Assess for epidural haematoma