Efficacy of Ultra-Sound Guided Iliohypogastric and Ilioinguinal Nerve Block for Endovascular Aortic Aneurysm Repair in a Case Unfit for Elective Open Surgery

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  • 腸骨鼠径・腸骨下腹神経ブロックによる腹部大動脈瘤ステントグラフト内挿術の麻酔管理

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Since 1991 when endovascular aortic aneurysm repair (EVAR) was first described in the literature, it has emerged as a less invasive alternative for conventional open surgical repair. As of 2007, two randomized controlled trials have demonstrated better outcomes with EVAR than with conventional open repair, at least in the first month after the procedure. Due to being less invasive, EVAR has been thought to be especially useful for patients unfit for elective open surgery. EVAR is minimally invasive compared to conventional open repair, nonetheless, only a few reports in the literature thus far have described the efficacy of the less invasive loco-regional anesthesia technique for EVAR. We describe here a case with abdominal aortic aneurysm complicated by severe obstructive respiratory insufficiency and angina pectoris that successfully underwent EVAR under the loco-regional anesthesia with ultra-sound guided iliohypogastric and ilioinguinal nerve block. The case described here suggests that in a patient in poor health who is considered unfit for open surgical repair, a less invasive anesthetic technique such as loco-regional anesthesia must be considered for the anesthetic management of EVAR.

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