Perioperative Anesthetic Management During Endovascular Repair of Stanford Type B Aortic Dissection: A Case Report And Narrative Literature Review Case Report and Review
Main Article Content
Abstract
Introduction: Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for complicated Stanford type B aortic dissection; however, procedural success depends on appropriate perioperative anesthetic management. We present a clinical case and a narrative review of the literature, emphasizing an anesthetic strategy focused on maintaining four key physiological objectives throughout the perioperative period.
Case Presentation: A 49-year-old man with a history of systemic arterial hypertension presented with an extensive Stanford type B aortic dissection associated with visceral malperfusion and underwent TEVAR. The procedure was performed under balanced general anesthesia with continuous hemodynamic and metabolic monitoring, intraoperative transthoracic echocardiography, and strict maintenance of mean arterial pressure between 70 and 80 mmHg using a norepinephrine infusion. During the intervention, an iatrogenic left femoral artery injury occurred, requiring immediate surgical repair and blood product transfusion. Despite this complication, hemodynamic stability, adequate tissue perfusion, and the absence of metabolic acidosis or hyperlactatemia were maintained throughout the procedure. The patient was successfully extubated in the operating room without neurological deficits and experienced an uneventful postoperative recovery, with no cardiovascular, neurological, or renal complications.
Discussion: This case highlights the importance of a structured anesthetic strategy based on physiological goals to minimize aortic wall stress, optimize perfusion of vital organs, and facilitate the early detection and management of intraoperative complications during TEVAR. The literature supports multimodal monitoring and individualized hemodynamic management as key components for improving perioperative outcomes in these patients.
Conclusion: Goal-directed anesthetic management represents an essential component of the endovascular treatment of Stanford type B aortic dissection. The proposed strategy provided sustained hemodynamic stability and a favorable clinical outcome despite an intraoperative vascular complication, suggesting that this reproducible approach may enhance perioperative safety in patients undergoing TEVAR.
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