A Retrospective Analysis of Comparison of General Versus Regional Anaesthesia for Endovascular Repair of Abdominal Aortic Aneurysm

Endovasküler Aort Anevrizması Onarımın Cerrahilerine Anestezist Bakışı; Tek Merkezli Retrospektif Bir Çalışma

Amaç: Minimal invaziv endovasküler stent greftleme yöntemleri olan endovasküler aort onarımı (EVAR) ve torasik endovasküler aort onarımı (TEVAR), aort anevrizmalarının tedavisinde geleneksel ve invaziv açık cerrahiye alternatif olarak uygulanmaktadır. Bu çalışmanın amacı hastanemizde EVAR ve TEVAR uygulanan hastalarda uygulanan anestezi yöntemlerini değerlendirmektir. Yöntemler: 01.01.2015-31.05.2022 tarihleri arasında endovasküler aort onarımı yapılan 95 hastanın dosyaları geriye dönük olarak incelendi. Hastalara ilişkin tanımlayıcı verilerin yanı sıra ameliyat süresi, yoğun bakım ve hastanede kalış süresi gibi veriler toplanarak değerlendirildi. Bulgular: Endovasküler aortik greftlemenin 14 hastaya genel anestezi (GA) (Grup GA) altında, 67 hastaya sedo-analjezi (SA) (Grup SA) altında yapıldığı belirlendi. 75 hastaya EVAR, 6 hastaya TEVAR uygulandı. EVAR hastalarının 11'inin GA, 64'ünün SA ile tedavi edildiği görüldü. Hastaların yaş ortalaması 68.73±8.31 yıl olup, 75'i erkekti. Hasta komorbiditeleri göz önüne alındığında gruplar arasında anlamlı fark yoktu (p>0.05). Yoğun bakımda kalış süreleri hastanede kalış süreleri açısından değerlendirildiğinde gruplar arasında istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Sonuç: Bu çalışmada kliniğimizde EVAR/TEVAR uygulanan hastalarda intraoperatif sıvı gereksinimi dışında anestezi yönteminin üstünlüğünü belirleyemedik.

Influence of Anesthetic Techniques on Perioperative Outcomes after Endovascular Aneurysm Repair

BACKGROUND

The purpose of the study was to explore the influence of anesthetic techniques on perioperative outcomes after endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) in a Chinese population.

METHODS

A retrospective review was performed in patients after elective EVAR for infrarenal AAA at our single center. Patients were classified into general anesthesia (GA), regional anesthesia (RA), and local anesthesia (LA) groups. The primary outcomes (30-day mortality and morbidity) and secondary outcomes [procedure time, mean arterial pressure (MAP), and length of hospital stay (LOS)] were collected and analyzed.

RESULTS

From January 2006 to December 2015, 486 consecutive patients underwent elective EVAR at our center. GA was used in 155 patients (31.9%), RA in 56 (11.5%), and LA in 275 (56.6%). The GA patients had fewer respiratory comorbidities, shorter and more angulated proximal necks, and more concomitant iliac aneurysms. LA during EVAR was significantly associated with a shorter procedure time (GA, P < 0.001; RA, P < 0.001) and shorter LOS (GA, P = 0.002; RA, P = 0.001), but a higher MAP (GA, P < 0.001; RA, P < 0.001) compared with GA and RA. LA was associated with a significantly lower risk of cardiac (odds ratio (OR) 4.27, 95% confidence interval (CI) 1.21-15.04), pulmonary (OR 5.37, 95% CI 1.58-18.23), and systemic complications (OR 4.15, 95% CI 1.85-9.33) compared with GA. RA was also associated with a decreased risk of systemic complications (OR 4.74, 95% CI 1.19-18.92) compared with GA. There was no difference in the 30-day mortality, neurologic complications, renal complications, and intraoperative extra procedures among the 3 groups.

CONCLUSIONS

Anesthetic techniques for EVAR have no influence on the 30-day mortality. LA for EVAR appears to be beneficial concerning the procedure time, LOS, and 30-day systemic complications for patients after elective EVAR for infrarenal AAA in the Chinese population.

Loco-regional versus general anaesthesia for elective endovascular aneurysm repair – results of a cohort study and a meta-analysis

Abstract. Background: The aim of this study was to investigate whether patients undergoing elective endovascular aneurysm repair (EVAR) with loco-regional anaesthetic techniques have better outcomes than those treated with general anaesthesia (GA). Patients and methods: We retrospectively evaluated outcomes of EVAR performed with regional anaesthesia (RA) or GA over a five-year period. Furthermore, we searched electronic bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) to identify studies comparing different anaesthetic methods in EVAR. We defined perioperative mortality and morbidity as well as length of hospital stay (LOS) as the primary outcome measures. Pooled effect estimates were calculated using fixed-effect or random-effects models. Results are reported as the odds ratio (OR) or mean difference (MD) and 95 % confidence interval (CI). Results: Three hundred and fifty-five patients underwent standard EVAR over the study period (RA, 215 patients; GA 140 patients). Patients in both groups had comparable baseline demographics and clinical characteristics. Perioperative mortality was significantly lower in the RA group (0.5 % vs. 4.3 %, P = 0.017). No difference was found in perioperative morbidity (P = 0.370), LOS (P = 0.146), postoperative destination (P = 0.799), reoperation (P = 0.355) or readmission within 30 days (P = 0.846). Meta-analysis of data on 15,472 patients from 15 observational studies found a significantly lower perioperative mortality (OR 0.70, 95 % CI 0.52–0.95, P = 0.02) and morbidity (OR 0.73, 95 % CI 0.55–0.96, P = 0.02) in patients treated with loco-regional anaesthetic techniques compared to those treated with GA. Our sub-group analysis demonstrated that both local anaesthesia (LA) (P = 0.003) and RA (P < 0.0001) were associated with a significantly shorter LOS compared to GA. Conclusions: Local and/or regional anaesthetic techniques may be advantageous over GA in elective EVAR, as indicated by reduced perioperative mortality and morbidity and a shorter hospital stay. Considering the current level of evidence, LA or RA should be considered in selected patients. Further clinical research is required to provide high level evidence on the optimal anaesthetic technique in EVAR.