title: Anesthesia technique and outcomes of endovascular aneurysm repair.
abstract: Anesthetic techniques vary widely in the endovascular repair of abdominal aortic aneurysms (EVAR). Previous studies have demonstrated the feasibility of using local anesthesia. However, the ideal anesthetic technique has not been determined. This study examines whether anesthetic technique influences the outcomes of EVAR. Data regarding demographics, risk factors, procedural characteristics, recovery characteristics, treatment complications, acute (<30 day) medical complications, mortality, and anesthetic type were prospectively collected during the AneuRx phase II aortic endograft trial. Patient cohorts receiving general, regional, or local anesthesia were compared. From 1997 to 1998, 424 patients underwent EVAR at 13 sites using the AneuRx Bifurcated endograft. There were 279 patients in the general anesthesia group, 95 patients in the regional group, and 50 patients in the local group. Risk factors were similar. There were no significant differences in age, gender, American Society of Anesthesiologists grade, length of anesthesia, branch artery occlusions, proximal endoleaks, failed implants, or open surgical conversions. Cardiac, renal, and wound-healing complications were all lower in the local group. Mortality was equivalent among the three groups. (p > 0.05, ANOVA). From these results we concluded that EVAR with local anesthesia is a safe and efficacious method that may reduce recovery times and postoperative medical morbidity compared to use of general or spinal/epidural anesthesia.
authors.affiliation: Division of Vascular Surgery, Johns Hopkins University, Baltimore, MD 21287, USA. jparra2@jhmi.edu
authors.forename: Jose R
authors.initials: JR
authors.lastname: Parra
authors.forename: Tami
authors.initials: T
authors.lastname: Crabtree
authors.forename: Robert B
authors.initials: RB
authors.lastname: McLafferty
authors.forename: Juan
authors.initials: J
authors.lastname: Ayerdi
authors.forename: Laura A
authors.initials: LA
authors.lastname: Gruneiro
authors.forename: Don E
authors.initials: DE
authors.lastname: Ramsey
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Hodgson
mesh_terms: D000367:Age Factors; D000762:Anesthesia Recovery Period; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000772:Anesthesia, Local; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome