Anesthetic management of external iliac artery transection in a morbidly obese patient with Klippel-Trenaunay-Weber syndrome: a case report

BACKGROUND: We report the anesthetic management of an external iliac artery transection in a morbidly obese patient with Klippel-Trenaunay-Weber syndrome (KTWS). CASE PRESENTATION: A 47-year-old man with KTWS was scheduled for a right external iliac artery transection. Preoperative CT showed a right external iliac artery aneurysm, a right superficial femoral artery aneurysm, and developed collateral vessels. General anesthesia was maintained with desflurane, remifentanil, and rocuronium bromide. After the transection of the right external iliac artery, the regional saturation of oxygen (rSO(2)) value of the right femoral did not decrease. There was no significant hemodynamic change before or after the transection. A non-ultrasound-guided rectus abdominis sheath block was performed due to the many collateral vessels. After extubation, the patient did not complain of postoperative pain. CONCLUSIONS: In the transection of lower-extremity blood arteries under laparotomy in patients with KTWS, rSO(2) monitoring, hemodynamic monitoring, and combined regional anesthesia could be useful.