Transfemoral endografting of thoracic aortic aneurysm under local anesthesia: a simple, safe and fast track procedure

Background: Endovascular aneurysm grafting of the descending thoracic aorta is a minimally invasive catheter technique, which is performed under gener al anesthesia. We describe a technique allowing to perform transfemoral end ovascular repair of thoracic aortic repair under local anesthesia Patients and methods: In 9 consecutive patients local anesthesia was perfor med in order to gain an opened femoral artery access for the delivery syste m, and a percutaneous access to the left brachial artery A pigtail catheter was then placed through the left brachial artery for the location of the o rigin of the left subclavian artery and/or the aneurysm and self-expanding endoprothesis was released under fluoroscopic guidance. For the deployment of the endograft a short period of controlled hypotension with nitroglyceri n bolus application was produced Results: All the aneurysms could be successfully sealed with the intended e ndovasccular technique. There was no vascular access complication or pulmon ary or ischemic (cardiac, cerebral or peripheral) complication. In the foll ow-up period of 6 +/- 3 months one patient needed a redo endovascular proce dure because of the development of a severe and symptomatic distal endoleak 6 weeks postoperative. This procedure was again performed under local anes thesia. Conclusions: From a technical point of view, transfemoral endovascular repa ir of thoracic aneurysm can be performed under local anesthesia. This is a very simple and fast track procedure which combines a minimally invasive ca theter technique and a less invasive anesthetic management.