Hemorrhage During Endovascular Repair of Thoracic Aorta

Abstract

A case of massive hemorrhage during thoracic endovascular aortic repair is presented. Removal of the endovascular sheath at the completion of the procedure precipitated the massive blood loss at the site of the iliac artery and was eventually controlled with surgical hemostasis, product transfusion, and vasopressor support. The prerequisites for performing a thoracic aorta endovascular repair and details of the surgical procedure are described. Preoperative anesthetic evaluation is discussed which includes need for blood product availability, adequate venous access, hemodynamic monitoring, and appropriate airway management in the event a thoracotomy is necessary for surgical control of hemorrhage. Lastly the differential diagnosis for an acute drop in end-tidal CO₂ despite a constant minute ventilation and no change in peak inspiratory pressures is described.