Endovascular repair of acute AAAs under local anesthesia with bifurcated endografts: a feasibility study.
OBJECTIVE
To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting.


METHODS
Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms. Complications and outcome of endovascular repair were evaluated; mortality was compared to a contemporaneous surgical cohort.


RESULTS
Seven (23%) of 31 patients having a standard surgical procedure died in the study period compared to 1 (6%) of 16 patients undergoing endovascular repair (following conversion to surgery because of calcified access vessels). Twelve (75%) of the endovascular repairs were performed under local anesthesia; no complications with this mode of anesthesia were encountered. The median duration of the endovascular procedures was 110 minutes (range 75-240); median blood loss was 250 mL (range 100-2800 mL). Only 4 patients required blood transfusion, and only 8 patients required admission to the intensive care unit. There were 3 postoperative complications (1 ischemic colitis, 1 renal failure, 1 groin hematoma). During follow-up, 3 endograft patients received stent-graft extensions in uneventful procedures. Two patients died at 9 and 16 months from cardiac causes.


CONCLUSIONS
This study demonstrates the feasibility and possible advantages of endovascular repair under local anesthesia in selected acute AAA patients. Further studies are needed to prove the advantages over open repair.
Verhoeven
Eric L G
EL
Department of Surgery, University Hospital of Groningen, The Netherlands. e.l.g.verhoeven@chir.azg.nl
Prins
Ted R
TR
van den Dungen
Jan J A M
JJ
Tielliu
Ignace F J
IF
Hulsebos
Robin G
RG
van Schilfgaarde
Reinout
R
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000295:instrumentation; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation