Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data.
BACKGROUND
Local and regional anesthesia was used in endovascular aortic aneurysm repair (EVAR) shortly after its introduction, and the feasibility has been documented several times. Nevertheless, locoregional anesthesia has not become accepted on a large scale, probably owing to a traditional surgical attitude preferring general anesthesia. This study compared various anesthesia techniques in patients treated with EVAR for infrarenal aortic aneurysms.


METHODS
From July 1997 to August 2004, 5557 patients who underwent EVAR repair in 164 centers were enrolled in the EUROSTAR registry. Data were compared among three groups: a general anesthesia group (GA-G) of 3848 patients (69%), a regional anesthesia group (RA-G) of 1399 patients (25%), and the local anesthesia group (LA-G) of 310 patients (6%). Differences in preoperative and operative details among the three study groups were analyzed using the chi(2) test for discrete variables and the Kruskal-Wallis test for continuous variables. Multivariate logistic regression analysis was performed on early complications.


RESULTS
The duration of the operation was reduced in the LA-G (115.7 +/- 42.2 minutes) compared with the RA-G (127.6 +/- 52.8 min, P < .0009) and GA-G (133.3 +/- 59.1 minutes, P < .0001). Admission to the intensive care unit was significantly less for LA-G patients (2%) than RA-G (8.3%, P = .0004) and GA-G (16.2%, P < .0001), but RA-G still had a distinct advantage (P < .0001) over GA-G. Hospital stay was significantly shorter in LA-G (3.7 +/- 3.1 days [P < .0001] vs GA-G [P = .007] vs RA-G), but RA-G (5.1 +/- 7.5 days) still had an advantage (P < .0001) vs GA-G (6.2 +/- 8.5 days). In EUROSTAR, systemic complications were significantly lower both for LA-G (6.6%, P = .0015) and RA-G (9.5%, P = .0007) than for GA-G (13.0%).


CONCLUSIONS
The EUROSTAR data indicate that patients appeared to benefit when a locoregional anesthetic technique was used for EVAR. Locoregional techniques should be used more often to enhance the perioperative advantage of EVAR in treating infrarenal aneurysms of the abdominal aorta.
Ruppert
Volker
V
Vascular Surgery, Hospital of Ludwig-Maximilian, University Munich, Campus Innenstadt, Munich, Germany. Volker.Ruppert@med.uni-muenchen.de
Leurs
Lina J
LJ
Steckmeier
Bernd
B
Buth
Jacob
J
Umscheid
Thomas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome