Intra-Operative Hypotension Should be Considered as a Risk Factor of Thrombo-Embolic Complications in Lengthy Endovascular Intervention for Elderly Aneurysm Patients

Abstract

Objective To avoid intraoperative rupture and thrombo-embolic complications during aneurysm embolization, cumulated individual experiences and high-quality equipment under a stable anesthesia is crucial especially in elderly. The aim of this study is to evaluate risk factors for thrombo-embolic complications during endovascular aneurysm embolization. Methods Retrospective study was performed to 303 procedures in 288 patients who underwent endovascular embolization for intracranial aneurysms during the period between Mar. 2007 and Oct. 2012. For these, hemodynamic data during intervention including blood pressure, oxygen saturation, pulse rate and temperature, as well as conventional demographic and radiographic data were assessed. Results As a whole, thrombo-embolic complications occurred in 36 patients (11.8%) with female predominance (80%) and older age (68.2 yrs). Of these, 11 patients suffered major deficits and 25 patients had minor or temporary sequels. In severely affected patients, elderly (p=0.02), prior use of ACE inhibitor (p=0.01), using multiple catheters >2.45 (p=0.025), and severe tortuosity more than 1.64 main arterial curvatures >90 degrees reaching the aneurysm (p=0.03) were significant risk factors. Intraoperative hypotension (p=0.01) and lengthy operation time >3.2 hr (p=0.02) are two major significant prognosticator for thrombo-embolic incidents. Conclusion In addition to the innate demographic and angiographic factors such as elderly and tortuous proximal arteries, intraoperative factors such as hypotension and longer operation time can result in thrombo-embolic complications. When attempting intervention in such risky conditions, any factors causing plugging or sluggishness of blood flow should be minimized or avoided with careful monitoring.