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Local anesthesia beneficial in EVAR for ruptured AAA
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Among patients undergoing endovascular repair of a ruptured abdominal aortic aneurysm, local anesthesia conferred better mortality rates than general anesthesia, researchers reported.
The researchers analyzed 226 patients who had EVAR for ruptured AAA with local anesthesia (mean age, 74 years; 80% men) and 1,510 who had it with general anesthesia (mean age, 73 years; 77% men) who were included in the Vascular Quality Initiative database between 2003 and 2017.
Compared with the general anesthesia group, the local anesthesia group had lower intraoperative time (P < .001), fewer intraoperative blood transfusions (P < .001), less intraoperative crystalloid administration (P < .001), shorter time in the ICU (P = .04) and fewer postoperative pulmonary complications (P = .04), Rumi Faizer, MD, from the division of vascular surgery at the University of Minnesota, and colleagues wrote.
Compared with the general anesthesia group, the local anesthesia group had reduced risk for mortality at 30 days (15.5% vs. 23.3%; adjusted HR = 0.7; 95% CI, 0.49-0.99) and 1 year (22.5% vs. 32.3%; aHR = 0.71; 95% CI, 0.53-0.96), according to the researchers.
The greatest mortality benefit from local anesthesia occurred in patients younger than 75 years and in those without preoperative hypotension. In patients with both characteristics, the aHR for mortality was 0.14 (95% CI, 0.03-0.57), and in patients with one characteristic, it was 0.57 (95% CI, 0.36-0.91).
“This analysis of the national [Vascular Quality Initiative] database demonstrates that EVAR under [local anesthesia for ruptured AAA] may be a safe treatment option compared with [general anesthesia] associated with lower morbidity and improved 30-day and 1-year mortality,” Faizer and colleagues wrote, noting that prospective analyses are needed to confirm the findings. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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