Principles of Anaesthesia in Endovascular Procedures

The principles of anaesthesia for endovascular procedures involve a careful balance of risk and benefit through comprehensive assessment, adequate preparation of the patient, and close collaboration with the interventional radiology team to ensure the success and safety of the patient. Procedure complexity, duration, patient comorbidities and patient preference all influence the choice of anaesthetic technique, which can involve general anaesthesia, regional anaesthesia, sedation, local anaesthesia, or a combination of methods. Major revascularisation, particularly of the aorta, can be achieved through local anaesthetic with light sedation. If anticipated to last 3–4 h, a general anaesthetic may be necessary. Complex aortic arch repairs may require rapid pacing to facilitate stent deployment. For thoracic aortic repairs, spinal ischaemia represents a small but important risk, and insertion of a spinal drain may be needed to mitigate this.