Anaesthetic Challenges of the Open Repair of Trauma Induced Femoral Pseudoaneurysm in CKD Patients Using the Combined Spinal Epidural Technique

Background: Multiple needling of femoral vessels for maintenance haemodialysis in patients with chronic kidney diseases without the use of ultrasounds poses a bigger risk for the development of pseudoaneurysms of femoral vessels. For those who incidentally develop vascular injury resulting in pseudoaneurysms of the femoral artery, which presents as groin swelling, a pulsatile and tender mass, often at risk of clot formation and distal limb vascular compromises etc. Open surgical repairs are commonly offered in Portharcourt Nigeria. The aim of this paper is to describe the challenges of providing perioperative care using the combined spinal epidural anaesthetic technique in these subsets of patients with chronic kidney diseaes requiring open surgical repair. Methsods: Prospective descriptive study involving all elective cases with vascular injury from haemodialysis presenting with pseudo-aneurysms for open vascular repair at the University of Portharcourt teaching hospital and some private hospitals in Portharcourt Nigeria. The study covered the period between January 2018 and January 2024. Ethical exemptions were obtained from the research and ethics committees of the various hospitals with the exclusion of patients with contraindications to neuraxial block and those less than 18 years. Results: Twenty-seven patients were offered the combined spinal epidural technique for open pseudo-aneurysmal repairs with an average duration of surgery of six to eight hours and post perioperative conditions and the outcome were satisfactory. Conclusion: The use of the combined spinal and epidural anaesthetic technique for femoral pseudo-aneurysmal repairs offered effective anaesthesia and satisfactory postoperative care with minimal complications.