The Short and Midterm Outcomes of Local Versus General Anesthesia for Non-Emergency Thoracic Endovascular Repair in Acute Type B Aortic Dissection

Abstract

Objective:

General anesthesia (GA) has consistently served as the predominant anesthesia modality in thoracic endovascular aortic repair (TEVAR). The objective of this retrospective study was to systematically evaluate and compare the short and midterm outcomes of local anesthesia (LA) versus GA for non-emergency TEVAR in acute Type B aortic dissection (TBAD).

Methods:

This single-center, retrospective study analyzed 441 consecutive patients who underwent non-emergent TEVAR between January 2016 and December 2020. Following 1:1 propensity score matching, 410 patients were enrolled and allocated into LA group (n=205) and GA group (n=205) based on anesthesia type. Baseline demographics, intraoperative details, postoperative outcomes, and follow-up data were systematically collected and analyzed. Patients were prospectively followed for 5 years post-discharge to monitor long-term outcomes.

Results:

Compared with the GA group, the LA group showed significantly shorter anesthesia duration (75 vs 125 minutes, p<0.001), procedure time (60 vs 95 minutes, p<0.001), intensive care unit (ICU) stay (4 vs 18 hours, p<0.001), and hospital stay (25 vs 29 days, p<0.001). However, no significant differences were found in in-hospital mortality (2.0% vs 2.9%, p=0.751) and late mortality (1.4% vs 2.5%, p=0.724) during the 5-year follow-up. Multivariable Cox-regression analysis revealed that chronic heart failure was an independent risk factor for death (HR=4.253, 95% CI 1.243-14.554, p=0.021).

Conclusion:

Local anesthesia may be considered non-inferior to GA in patients with acute TBAD undergoing non-emergency TEVAR, with shorter length of ICU and hospital stay. Moreover, it exhibited equivalent 5-year survival rates to GA.

Clinical Impact

These findings demonstrate that LA offers a resource-sparing alternative without compromising survival, thereby supporting a paradigm shift toward LA as a potential primary anesthetic strategy for TEVAR in appropriately selected patients.

Keywords

LA GA TEVAR type B aortic dissection outcomes

Get full access to this article

View all access options for this article.

References

Upchurch

Jr Escobar

Azizzadeh

, et al. Society for vascular surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021;73(1S):55S–83S.

Cheng

Chen

Tran-McCaslin

, et al. Endovascular abdominal aortic aneurysm repair: does anesthesia type matter. Ann Vasc Surg. 2019;61:284–290.

Moll

Powell

Fraedrich

, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg. 2011;41 suppl 1:S1–S58.

Dake

Miller

Semba

, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331:1729–1734.

Krajcer

Ramaiah

Henao

, et al. Perioperative outcomes from the prospective multicenter least invasive fast-track EVAR (LIFE) registry. J Endovasc Ther. 2018;25(1):6–13.

Harky

Ahmad

Santoro

, et al. Local versus general anesthesia in nonemergency endovascular abdominal aortic aneurysm repair: a systematic review and meta analysis. J Cardiothorac Vasc Anesth. 2020;34(4):1051–1059.

Zottola

Kruger

Kong

, et al. Locoregional anesthesia is associated with reduced hospital stay and need for intensive care unit care of elective endovascular aneurysm repair patients in the vascular quality initiative. J Vasc Surg. 2022;77:1061–1069.

Faizer

Weinhandl

El Hag

, et al. Decreased mortality with local versus general anesthesia in endovascular aneurysm repair for ruptured abdominal aortic aneurysm in the vascular quality initiative database. J Vasc Surg. 2019;70(1):92–101.

Harky

Fan

Kwok

, et al. Local anaesthetic technique in endovascular abdominal aortic aneurysm repair: is it time to change the paradigm? J Vasc Med Surg. 2018;06:1000376.

10.

Boehm

Baumgarten

Hoeft

Preoperative patient assessment: identifying patients at high risk. Best Pract Res Clin Anaesthesiol. 2016;30(2):131–143.

11.

Edwards

Andrews

Edwards

, et al. Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American college of surgeons national surgical quality improvement program database. J Vasc Surg. 2011;54:1273–1282.

12.

Abisi

Musto

Lyons

, et al. Awake spinal cord monitoring under local anesthesia and conscious sedation in fenestrated and branched endovascular aortic repair. J Endovasc Ther. 2021;28(6):837–843.

13.

Rocha

Lindsay

Friedrich

, et al. Systematic review of contemporary outcomes of endovascular and open thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2020;71(4):1396–1412.

14.

Etz

Weigang

Hartert

, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European association for cardio-thoracic surgery. Eur J Cardiothorac Surg. 2015;47(6):943–957.

15.

Noh

Choi

Kwon

, et al. General anesthesia versus local anesthesia for endovascular aortic aneurysm repair. Medicine. 2018;97:e11789.

16.

Haji-Zeinali

Mansouri

Raeis Hosseini

, et al. Five-year survival and complications of thoracic endovascular aortic repair (TEVAR): a single tertiary center registry for all-comers patients. Cardiovasc Revasc Med. 2023;51:23–30.