Thoracic Endovascular Aortic Repair (TEVAR) under Local and Intravenous Anaesthesia: A Case Report

Abstract

Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive procedure used to treat various thoracic aortic pathologies. Anesthetic management is crucial for optimizing outcomes, particularly in high-risk patients. We present a case of TEVAR performed under local and intravenous anesthesia in a patient with significant comorbidities. A 61-year-old male with type 2 diabetes mellitus, systemic hypertension, chronic smoking, and alcoholism presented with lower limb burning sensation, exertional dyspnea (NYHA class 2), chest pain, and exertional giddiness. CT angiogram revealed an aortic arch pseudoaneurysm. TEVAR was performed under local anesthesia and intravenous sedation. Vital signs were stable (HR: 88bpm, BP: 150/100mmHg, SpO2: 99%). Bilateral femoral and left radial artery accesses were used, deploying a thoracic aortic graft distal to the left subclavian artery. Post-procedure angiogram showed successful graft deployment without complications. TEVAR under local and intravenous anesthesia is a safe and effective approach, particularly in high-risk patients. This case highlights the importance of individualized anesthetic management and the benefits of a minimally invasive approach in reducing perioperative morbidity. Further studies are warranted to validate the efficacy and safety of this technique in diverse patient populations.