| Intra-Operative Hypotension Should be Considered as a Risk
Factor of Thrombo-Embolic Complications in Lengthy
Endovascular Intervention for Elderly Aneurysm Patients |
|
Dong Hyeon Bae1 , Kyu-Sun Choi1 , Hyeong-Joong Yi1 , Dong-Won Kim2 , Yong Ko1 , Koang Hum Bak1 |
|
Departments of 1Neurosurgery, 2Anesthesiology and Pain Medicine, Hanyang University School of Medicine, Seoul, Korea |
|
|
| Abstract |
Objective
To avoid intraoperative rupture and thrombo-embolic complications during aneurysm embolization, cumulated
individual experiences and high-quality equipment under a stable anesthesia is crucial especially in elderly. The aim
of this study is to evaluate risk factors for thrombo-embolic complications during endovascular aneurysm embolization.
Methods
Retrospective study was performed to 303 procedures in 288 patients who underwent endovascular embolization
for intracranial aneurysms during the period between Mar. 2007 and Oct. 2012. For these, hemodynamic
data during intervention including blood pressure, oxygen saturation, pulse rate and temperature, as well as conventional
demographic and radiographic data were assessed.
Results
As a whole, thrombo-embolic complications occurred in 36 patients (11.8%) with female predominance (80%)
and older age (68.2 yrs). Of these, 11 patients suffered major deficits and 25 patients had minor or temporary sequels.
In severely affected patients, elderly (p=0.02), prior use of ACE inhibitor (p=0.01), using multiple catheters >2.45
(p=0.025), and severe tortuosity more than 1.64 main arterial curvatures >90 degrees reaching the aneurysm
(p=0.03) were significant risk factors. Intraoperative hypotension (p=0.01) and lengthy operation time >3.2 hr (p=0.02)
are two major significant prognosticator for thrombo-embolic incidents.
Conclusion
In addition to the innate demographic and angiographic factors such as elderly and tortuous proximal
arteries, intraoperative factors such as hypotension and longer operation time can result in thrombo-embolic complications.
When attempting intervention in such risky conditions, any factors causing plugging or sluggishness of blood
flow should be minimized or avoided with careful monitoring. |
| Key Words:
AneurysmㆍElderlyㆍEndovascular embolizationㆍHypotensionㆍMultiple catheterizationㆍThrombo-embolic complication |
|
PDF Links
Download Citation
