One-Week Postoperative Patency of Lower Extremity In Situ Bypass Graft Comparing Epidural and General Anesthesia: Retrospective Study of 822 Patients

Wiis, J.; Jensen-Gadegaard, Peter; Altintas, Ümit; Seidelin, C; Martusevicius, Robertas; Mantoni, Teit

doi:10.1016/j.avsg.2013.01.027

Cited by 14 publications

(5 citation statements)

References 14 publications

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“…Based on the DVR, several different types of studies have been conducted, for example, Impact of β-blockers on patients treated for peripheral arterial disease:2 this study showed a reduced risk of amputation but increased risk of myocardial infarction or stroke.Influence of type of anesthesia on the patency of peripheral bypass:3 hypothesizing that epidural anesthesia could positively affect 30-day patency because of an increased regional blood flow; the study showed that the choice of anesthesia does not affect the 7-day patency.Benefit of open repair versus endovascular repair for electively asymptomatic abdominal aortic aneurysm repair was investigated during a 4-year period:4 this (national) study showed that the results found in the previous randomized studies of a benefit in 30-day survival with endovascular repair were also seen in daily Danish practice. Furthermore, it showed that after 20 months, there was no difference in survival between the two treatment modalities.…”

Section: Main Variablesmentioning

confidence: 97%

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The Danish Vascular Registry, Karbase

Eldrup

Cerqueira

Motte

et al. 2016

CLEP

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AimThe Danish Vascular Registry (DVR), Karbase, is monitoring arterial and advanced vein interventions conducted at all vascular departments in Denmark. The main aim of the DVR is to improve the quality of treatment for patients undergoing vascular surgery in Denmark by using the registry for quality assessment and research.Study populationAll patients undergoing vascular interventions (surgical and endovascular) at any vascular department in Denmark are registered in the DVR. The DVR was initiated in 1989, and each year, ∼9,000 procedures are added. By January 2016, >180,000 procedures have been recorded. Since 2001, data completeness has been >90% (compared to the Danish National Patient Register).Main variablesVariables include information on descriptive patient data (ie, age, sex, height, and weight) and comorbidity (ie, previous cardiovascular disease and diabetes). Process variable includes waiting time (time from event to medical contact and treatment) and the type of procedures conducted. Outcome variables for in-hospital complications (ie, wound complications, myocardial infarction, stroke, amputation, respiratory complications, and renal insufficiency) and 30-day patency are submitted. Variables for medical treatment (antithrombotic and statin treatment), amputation, and survival are extracted from nationwide, administrative registers.ConclusionThe DVR reports outcome on key indicators for monitoring the quality at all vascular departments in Denmark for the purpose of quality improvement. Furthermore, data are available for research and are being used in international collaborations on changes in clinical practices.

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Section: Main Variablesmentioning

confidence: 97%

“…Influence of type of anesthesia on the patency of peripheral bypass:3 hypothesizing that epidural anesthesia could positively affect 30-day patency because of an increased regional blood flow; the study showed that the choice of anesthesia does not affect the 7-day patency.…”

Section: Main Variablesmentioning

confidence: 99%

The Danish Vascular Registry, Karbase

Eldrup

Cerqueira

Motte

et al. 2016

CLEP

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“…As increasingly complex patients undergo infrainguinal revascularization 8 , further additional evidence is required to define the relationship between anaesthetic technique and graft patency, which represents a potentially modifiable factor. Early studies suggested a possible association between neuraxial anaesthesia and decreased rates of reoperation 9 , 10 and graft failure 10 , 11 , but subsequent studies (using data from before 2011) did not find an association between anaesthesia technique and 7-day 12 or 30-day graft failure 5 . Plausible mechanisms by which RA may impact graft patency include sympathetic blockade, decreased catecholamine release, and improved lower limb blood flow 5 .…”

Section: Introductionmentioning

confidence: 99%

Association of anaesthesia technique with 30-day primary graft patency after open lower limb revascularization: retrospective cohort study

Flexman

Schwarz

et al. 2022

BJS Open

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Background The relationship between anaesthetic technique and graft patency after open lower limb revascularization is unclear. The aim of this study was to evaluate the association between 30-day graft patency after elective infrainguinal bypass and anaesthetic technique (regional anaesthesia (RA, i.e. neuraxial and/or peripheral nerve blockade) compared with general anaesthesia (GA)). Methods Patients who underwent elective infrainguinal bypass in the 2014–2019 National Surgical Quality Improvement Program Vascular Procedure Targeted Lower Extremity Open data set were included. Excluded patients were those under 18 years old, those who did not receive RA or GA, and/or had an international normalized ratio of 1.5 of greater, a partial thromboplastin time more than 35 s, or a platelet count less than 80 × 109/L. The primary outcome was primary graft patency without reintervention. The relationship between anaesthetic technique and patency was analysed with multivariable logistic regression. Results Included were 8893 patients with a mean(s.d.) age of 68(11) years and 31.5 per cent female. Within the cohort, 7.7 per cent (n = 688) patients received RA only, 90.4 per cent (n = 8039) GA only, and 1.9 per cent (n = 166) both GA and RA. In the RA-only group, 91.7 per cent (631 of 688) received neuraxial anaesthesia. The primary patency rate was 93.2 per cent (573 of 615) for RA only, and 91.5 per cent (6390 of 6983) for GA only (standardized mean difference, 0.063). RA was not associated with a higher rate of patency compared with GA (adjusted OR, 1.16; 95 per cent c.i., 0.83 to 1.63; P = 0.378). Conclusion There was no association between anaesthetic technique and 30-day graft patency after elective infrainguinal bypass surgery. Further prospective studies would be useful to study the impact of anaesthesia technique on important patient-centred outcomes such as long-term patency and non-home discharge.

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“…Although this method may meet the surgical requirement, it has multiple postoperative complications, and may lead to greater hemodynamic changes, including rapid blood pressure decrease or even respiratory and circulatory inhibition ( 1 , 2 ). Therefore, ensuring intraoperative anesthetic safety and reducing surgical and anesthetic complications are essential ( 3 , 4 ). In recent years, the application of peripheral nerve block technology has attracted much attention ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…Lumbar plexus-sciatic nerve block (LSB) has less interference on patients' respiration and circulation in lower extremity surgery, and does not affect the gastrointestinal and urinary functions ( 5 – 7 ). In addition, it may avoid lumbar puncture injury and achieve accurate positioning in peripheral nerve block anesthesia when using a nerve stimulator, as well as long anesthetic duration and satisfactory results ( 3 – 5 ). Ropivacaine (ROP) is a long-acting amide local anesthetic that is widely used within clinics due to its low toxicity towards the central nervous system and cardiovascular system ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of local administration of various doses of dexmedetomidine on ropivacaine‑induced lumbar plexus‑sciatic nerve block

Shan

Nie

2018

Exp Ther Med

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The present study aimed to investigate the impact of various doses of dexmedetomidine (DEX) on ropivacaine (ROP)-induced lumbar plexus-sciatic nerve block (LSB). A total of 80 patients who underwent ankle surgery under LSB were divided into group R (applied with 30 ml 5% ROP), Dex1 (30 ml 0.5% ROP + 1 µg/kg DEX), Dex2 (30 ml 0.5% ROP + 1.5 µg/kg DEX) and Dex3 (30 ml 0.5% ROP + 2 µg/kg DEX), with 20 cases in each group. The onset time and duration of sensory and motor block, mean arterial pressure (MAP), heart rate (HR), oxygen saturation, Ramsay score, serum vascular endothelial growth factor (VEGF) level and adverse reactions in the four groups were observed. Results demonstrated that the durations of sensory and motor block in group R were shorter than those in groups Dex1-3 (P<0.01), followed by the sequence of group Dex1

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One-Week Postoperative Patency of Lower Extremity In Situ Bypass Graft Comparing Epidural and General Anesthesia: Retrospective Study of 822 Patients

Cited by 14 publications

References 14 publications

The Danish Vascular Registry, Karbase

The Danish Vascular Registry, Karbase

Association of anaesthesia technique with 30-day primary graft patency after open lower limb revascularization: retrospective cohort study

Impact of local administration of various doses of dexmedetomidine on ropivacaine‑induced lumbar plexus‑sciatic nerve block

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