TY - CHAP M1 - Book, Section TI - Chapter 91. Thoracoabdominal Aneurysm A1 - Nishanian, Ervant A1 - Shaefi, Shahzad A2 - Atchabahian, Arthur A2 - Gupta, Ruchir PY - 2013 T2 - The Anesthesia Guide AB - Often associated with HTN, atherosclerosis, and connective tissue disorders such as Marfan syndromeBest surgical series has 10% mortalityHigh risk of rupture along with aortic dissection. Untreated aortic dissection carries a 25–35% mortality within the first few daysComorbiditiesPVDCADHTNChronic obstructive pulmonary disease (COPD) (smokers)Renal impairment (independent predictor of postop renal failure and mortality)Anticipate potential for rapid large blood loss and hemodynamic shifts. Successful outcome requires maintenance of adequate cardiac output and flow to vital organs including the spinal cord while avoiding hypertension and aortic ruptureRisk of paraplegia ≥3.5% blood as supply to the anterior spinal artery involved. Techniques to reduce incidence of paraplegia include: Epidural cooling of the spinal cord during surgeryCerebrospinal fluid drainageReimplantation of intercostal arteriesSSEP monitoringProvision of distal aortic perfusion during surgery with the use of atriofemoral (left atrium) bypass to the distal aortaEndovascular repairs are possible in patients that have appropriate anatomy. However, be prepared to convert to open procedure SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=57261762 ER -