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In der letzten Dekade wurde die Behandlung von Erkrankungen der Aorta thoracica descendens und abdominalis durch die Einführung transluminaler Methoden auf der Basis von Stent-grafts revolutioniert. Insbesonders ältere, polymorbide Patienten werden von dieser Alternative profitieren, da wir noch über keine Langzeitergebnisse verfügen. Aortale Pathologien wie das asymptomatische oder rupturierte Aneurysma, die akute Plaqueruptur, die traumatische Aortenruptur oder die akute B-Dissektion und andere seltenere Entitäten können endoluminal versorgt werden. Die Gefäßanatomie ist zur Zeit die wichtigste Einschränkung der Applizierbarkeit dieser Methode.

Introduction: acute haemodynamic changes and/or loss of abdominal muscle tone can occur during induction of general anaesthesia and may be the Achilles' tendon in endovascular aneurysm repair (EVAR) of ruptured aortoiliac aneurysms (rAIA). The purpose of this study was to evaluate the use of local anaesthesia (LA) for EVAR to overcome these limitations. Methods: twenty-one consecutive patients with rAIA are included in this study. Twenty patients underwent EVAR under LA, and 1 patient was treated under general anaesthesia. Haemodynamics were stabilised during assessment of EVAR feasibility by CT-scan and during the procedure itself by controlled hypotension (MAP 50–60 mmHg) and moderate fluid resuscitation. Results: median procedure time was 120 min. Haemodynamics remained stable in all but 3 patients who required transfemoral balloon occlusion of the supra-renal aorta. Perioperative intubation was necessary in 5 patients because of respiratory distress (n=3), or retroperitoneal access (n=2). Temporary deterioration of renal function occurred in 6 patients, with 2 requiring hemofiltration. CT-scan confirmed sealing of the rAIA in all patients at discharge. 30-day mortality was 9.5% (2 deaths). In the median follow-up of 19 months, there were no deaths, but 3 endovascularre-interventions, 1 crossover femoro-femoral bypass, and 1 open surgical graft repair. Discussion: our series is the first to show that EVAR for rAIA can be safely performed under LA. This approach allows implantation of commercially available bifurcated SG and improves patient outcome. Copyright 2002 Elsevier Science Ltd