Endovascular repair of perirenal and Group IV thoracoabdominal aortic aneurysms: A case study report

Background

Endovascular aneurysm repair (EVAR) is an established technique used in infrarenal aneurysms. Fenestrated and branched endografts (FBEGs) are a new option for the treatment of perirenal and Group IV thoracoabdominal aortic aneurysms (TAAAs). With a case study design, the preparation, surgical technique, postoperative nursing care, and medical follow-up involved in Group IV TAAAs treated with an FBEG are discussed.

Methods

Detailed imaging with state-of-the-art computed tomography scanning is used to create a custom-made endograft in which a combination of fenestrations, scallops, and covered or uncovered stents are used for the visceral arteries. This graft can be introduced in the arterial system through the femoral artery and delivered at the level of the perivisceral abdominal aorta. Perioperative nursing care in patients undergoing FBEG draws from protocols of an established EVAR program. With these protocols, preoperative assessment and education are completed to ensure that the patient is both physically and mentally prepared for the surgery. Intraoperatively, the nursing team is instrumental in the functioning of the case: The scrub nurse assists the surgeon while other registered nurses assist with invasive monitoring and emotional support for the conscious patient. Postoperatively, patients are taken directly from the recovery room to a step-down bed where close monitoring occurs.

Results

The use of FBEGs to treat Group IV TAAAs reduces the acuity of patient care by avoiding a thoracotomy and major surgical dissection, thus decreasing hospital length of stay. Although long-term follow-up remains limited, durability seems to be promising, and this procedure offers a viable option to high-risk patients. Because EVAR with FBEG is a new procedure in Canada, nurses involved with every aspect of care are challenged to maintain high levels of competency by continually educating themselves in this evolving field.