Thoracic Endovascular Aortic Repair with Chimney Technique (Chimney TEVAR) for Aortic Arch Pathologies: Cardiovascular Problems during Anesthesia
Wacharin Sindhvananda MD, PhD*, Fontip Leelachiewchankul MD**
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ** Department of Anesthesiology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Background : Chimney TEVAR is a new alternative surgical treatment for aortic arch pathologies. As being a developing
surgical technique, there might be some unknown cardiovascular problems during anesthesia.
Objective : To investigate cardiovascular problems during anesthesia.
Material and Method: Retrospective review of medical records between 2010 and 2013 found that chimney TEVAR were
operated in 16 cases. From anesthetic records, cardiovascular parameters were collected and descriptive statistic and
pair-t-test were applied; abnormal events were focused, traced, and logically depicted.
Results : During chimney insertion, NIBP (at left) were used instead of IBP (at right) in 50% of cases, MAP was lowest,
and CVP was increased. Overall during surgery, decreasing of MAP from baseline (mean = -36.25±21.94 mmHg) was
observed throughout the operation and with statistical significance. Serious cardiovascular instability of 12.5% were
observed. Base on blood transfusion and hematocrit level, the assessed amount of blood loss was inappropriate and
underestimated in 75% of cases.
Conclusion : 1) It was not safe to monitor blood pressure only at right arm, 2) underestimated assessment of blood loss was
common and caused hypotension, 3) volume status was hardly assessed by basic monitors and CVP did not help for volume
assessment, and 4) fatal cardiovascular instability could happen.
Keywords : Chimney, TEVAR, Innominate, Blood loss estimation, Hypotension
