Anesthesia choice for endovascular repair of complex abdominal aortic aneurysm: A propensity-score-matched study from the ACS-NSQIP database from 2012 to 2022

Abstract

Background

While general anesthesia has been the dominant anesthesia used in endovascular aneurysm repair (EVAR), locoregional anesthesia is suggested as a viable alternative for eligible patients. However, the majority of previous findings came from infrarenal EVAR while the choice of anesthesia for complex EVAR remains less established. This study aimed to retrospectively compare the 30-day outcomes of patients who underwent non-emergency complex EVAR under locoregional or general anesthesia.

Methods

Patients who had EVAR for complex abdominal aortic aneurysm (AAA) were selected from ACS-NSQIP targeted database between 2012 and 2022. Complex AAA included juxtarenal, suprarenal, or pararenal proximal extent, Type IV thoracoabdominal aneurysm, and/or aneurysms treated with Zenith Fenestrated endograft. Exclusion criteria included age under 18 years, ruptured AAA, acute intraoperative conversion to open, and emergency. A 1:2 propensity-score matching was used to balance demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, and concomitant procedures between the locoregional and general anesthesia groups. Thirty-day outcomes were examined.

Results

There were 284 (9.63%) and 2664 (90.37%) patients who underwent EVAR for complex AAA under locoregional and general anesthesia, respectively. All patients under locoregional anesthesia were matched to 549 patients under general anesthesia. Patients under locoregional and general anesthesia had comparable risks of mortality and surgical complications. However, patients under locoregional anesthesia had a shorter hospital length of stay (LOS; 2.37 ± 3.25 vs 3.35 ± 4.81 days, p < .01).

Conclusion

Both locoregional and general anesthesia are effective options for eligible patients undergoing complex EVAR. However, patients under general anesthesia had a longer hospital LOS by about 1 day, which was likely due to increased case complexity that may necessitate prolonged recovery and closer monitoring for complications. To further optimize anesthesia protocols for these procedures, future prospective studies may be necessary.

Keywords

EVAR anesthesia complex AAA endovascular aneurysm

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