Endovascular Abdominal Aortic Aneurysm Repair: Does Anesthesia Type Matter?

Cheng, Michael; Chen, Qiaoling; Tran-McCaslin, Marie; Chun, Linda; Lew, Wesley K.; Patel, Kaushal

doi:10.1016/j.avsg.2019.04.031

Cited by 12 publications

(14 citation statements)

References 13 publications

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“…2,4,6 There is increasing literature reporting on the benefits of PEVAR with locoregional and/or MAC and local anesthesia compared to GA, with decrease in complications, particularly pulmonary. 11,14,16 Shorter operative time, decreased LOS, and postoperative complication rates have also been reported with locoregional, MAC, and local anesthesia. 7,10,18 The results detailed in our study show that PEVAR, overall, yields much better outcomes than EVAR with FC in line with current literature; there are significantly lower EBL, decreased access and local wound complications, and 30-day major adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…The apparent benefits of the latter modality include shorter intensive care unit stays, decreased rates of pneumonia, and a lower 30day mortality. [10][11][12][13][14][15][16] In addition to improved patient outcomes, MAC also appears to yield a cost benefit, as patients are discharged sooner with fewer readmissions due to operative complications. 17 Previous literature investigating the outcomes of PEVAR with MAC and local anesthesia compared to GA has largely focused on retrospective reviews of national databases, including the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) or small institutional case series.…”

Section: Introductionmentioning

confidence: 99%

“…The apparent benefits of the latter modality include shorter intensive care unit stays, decreased rates of pneumonia, and a lower 30-day mortality. 10–16 In addition to improved patient outcomes, MAC also appears to yield a cost benefit, as patients are discharged sooner with fewer readmissions due to operative complications. 17…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous endovascular abdominal aortic aneurysm repair with monitored anesthesia care decreases operative time but not pulmonary complications

et al. 2021

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Objectives To report our experience and compare the results of percutaneous endovascular aortic aneurysm repair (PEVAR) performed under monitored anesthesia care (MAC) to PEVAR under general anesthesia (GA). Methods A retrospective review of patients who underwent non-emergency endovascular abdominal aortic aneurysm repair (EVAR) was completed. Patients were excluded if they had a complex repair, including fenestrated, branched, or parallel endografting. Demographics, operative data, 30-day mortality/morbidity and postoperative outcomes were analyzed. Results A total of 159 patients were identified with a median age of 69. 115 patients had PEVAR, 45 (39.1%) PEVAR MAC and 70 (60.9%) PEVAR GA. PEVAR MAC compared to PEVAR GA had decreased operative time (106 vs. 134 min, P < 0.001), time in the operating room (163 vs. 245 min, P = 0.016), and estimated blood loss (EBL) (115 vs. 176 mL P = 0.012). There was no statistically significant difference in the hospital length of stay (LOS) (1.9 vs. 2.7 days, P = 0.133), and post-operative complications including pulmonary (2.2 vs. 2.9%, P = 0.835). Forty-four patients had EVAR with a femoral cutdown (FC), including 14 PEVAR conversions. PEVAR conversion was associated with higher EBL (543 vs. 323 mL, P = 0.03), operative time (230 vs. 178 min, P = 0.01), and operating room time (307 vs. 275 min, P = 0.01) compared to planned EVAR with FC. Conclusions PEVAR under MAC is associated with shorter time in the operating room compared to PEVAR under GA. PEVAR under MAC does however not decrease overall morbidities, including postoperative pulmonary complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous endovascular abdominal aortic aneurysm repair with monitored anesthesia care decreases operative time but not pulmonary complications

et al. 2021

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“…However, there are many studies in the literature emphasizing the superiority of one anaesthesia technique over another. In a study by Cheng et al it was emphasized that LA is advantageous in terms of operation time and hospital stay, and LA and RA are safe and effective options for elective EVAR cases [ 6 ]. In another study investigating the effect of anaesthesia type on perioperative outcomes, LA was associated with fewer pulmonary complications and it was stated that surgeons should consider the broader use of LA in appropriate EVAR cases [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Mini-endovascular aneurysm repair: a minimalist approach for a minimally invasive procedure

Ünlü¹,

Durukan²

2021

kitp

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Introduction: Abdominal aortic aneurysms represent the majority of all aneurysms of the aorta. Endovascular aneurysm repair (EVAR) is an alternative procedure to surgical repair. Although general and regional anaesthesia are frequently used during EVAR procedures, local anaesthesia has become one of the anaesthesia options for which there is increasing experience. Aim: We reported our EVAR cases in which we routinely used femoral local anaesthesia. Material and methods: Between August 2016 and June 2020, the EVAR procedure was applied to 22 infrarenal abdominal aortic aneurysm patients under femoral local anaesthesia. Open femoral artery access through a groin incision was used in all patients. Patients were followed up for graft-and wound-related complications. Results: The mean age of the patients was 72.59 ±6.6 years (min: 60, max: 84). Mean aneurysm sac diameter was 61.04 ±8.76 mm. Bifurcated stent graft was used in 21 (95.5%) patients. An aorto-uni-iliac stent graft was used for 1 (4.5%) patient due to contralateral total iliac occlusion. Endoleak was observed in 6 patients. In-hospital mortality was observed in 2 patients; both cases were ruptured with haemodynamic instability (9%). Revision in the groin area was performed in 3 (13.6%) patients due to local wound complications. Conclusions: Although the EVAR procedure has been described as a safer and more easily applicable alternative to surgical repair, it is disadvantageous in terms of increasing treatment costs. Anaesthesia preference and incision size with a more minimalist approach can reduce the length of hospital stay and minimize the complications that may occur after the procedure, resulting in decreased costs.

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“…Unterschiedliche Anästhesieverfahren, u. a. Analgosedierung, Spinal-und Epiduralanästhesie, wurden mit einer Allgemeinanästhesie während der endovaskulären Versorgung von abdominalen Aortenaneurysmen in prospektiven Beobachtungsstudien verglichen. Dabei zeigte sich kein signifikanter Unterschied in der Inzidenz postoperativer Schlaganfälle [58,59]. Auch für den kathetergestützten perkutanen Aortenklappenersatz konnte bisher kein signifikanter Einfluss des Anästhesieverfahrens auf das Auftreten perioperativer Schlaganfälle nachgewiesen werden [60,61].…”

Section: Wahl Des Anästhesieverfahrensunclassified

Perioperativer Schlaganfall

Fischer

Kahl

2020

Anaesthesist

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Endovascular Abdominal Aortic Aneurysm Repair: Does Anesthesia Type Matter?

Cited by 12 publications

References 13 publications

Percutaneous endovascular abdominal aortic aneurysm repair with monitored anesthesia care decreases operative time but not pulmonary complications

Percutaneous endovascular abdominal aortic aneurysm repair with monitored anesthesia care decreases operative time but not pulmonary complications

Mini-endovascular aneurysm repair: a minimalist approach for a minimally invasive procedure

Perioperativer Schlaganfall

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