This article is more than 5 years old. Information may no longer be current.

Local anesthesia may lower mortality in patients undergoing EVAR for ruptured AAA

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

In patients with ruptured abdominal aortic aneurysm undergoing endovascular repair, local anesthesia was linked to lower rates of mortality compared with general anesthesia, according to data from the Vascular Quality Initiative.

The researchers analyzed 2,409 patients (78% men) with ruptured abdominal aortic aneurysm (AAA) from the Vascular Quality Initiative database who underwent repair between 2003 and 2015 with open surgery (n = 1,265), endovascular aneurysm repair (EVAR) with local anesthesia (n = 140) or EVAR with general anesthesia (n = 1,004).

The outcomes of interest were 30-day mortality and 1-year mortality.

After adjustment for age, race and sex, compared with EVAR with general anesthesia, EVAR with local anesthesia was associated with reduced 30-day mortality (16.5% vs. 24.3%; adjusted HR = 0.65; P = .045) and reduced 1-year morality (25% vs. 33%; adjusted HR = 0.71; P = .048), Rumi Faizer, MD, associate professor of surgery and chief of the division of vascular surgery, University of Minnesota, Minneapolis, reported at the Society for Vascular Surgery 2016 Vascular Annual Meeting.

When Faizer and colleagues conducted a subgroup analysis, they determined that factors most related to benefits from EVAR with local anesthesia included age (P = .025) and lowest preoperative systolic BP (P = .005).

Patients aged at least 75 years with lowest preoperative systolic BP less than 90 mm Hg had greater mortality benefit from EVAR with local anesthesia compared with patients with neither risk factor (30-day mortality, 3% vs. 13%; adjusted HR = 0.16) or one risk factor (30-day mortality, 9% vs. 23%; adjusted HR = 0.41), according to the researchers. However, both anesthesia approaches resulted in similar 30-day mortality rates in patients with both risk factors (local, 43%; general, 40%; adjusted HR = 1.09).

Compared with EVAR with general anesthesia, EVAR with local anesthesia was associated with fewer intraoperative transfusions (2.1 L vs. 3 L; P < .01) and shorter ICU length of stay (4.4 days vs. 5.6 days; P < .05), according to the researchers.

“EVAR under local anesthesia for [ruptured] AAA is recommended as a safe treatment option, with lower morbidity and improved 30-day and 12-month mortality in certain patients,” Faizer and colleagues wrote in an abstract. “A prospective evaluation of the role of ruptured EVAR under local anesthesia will provide important data to evaluate treatment protocols.” – by Erik Swain

Reference:

Faizer R, et al. Plenary Session 6: RS15. Presented at: Society for Vascular Surgery 2016 Vascular Annual Meeting; June 8-11, 2016; National Harbor, Md.

Disclosure: Faizer reports serving on the speakers’ bureau for Medtronic.