Local Versus General Anesthesia in Patients Undergoing Thoracic Endovascular Aortic Repair

نویسندگان

چکیده

General anesthesia is associated with inherent risks that can be avoided less invasive anesthetic strategies. We hypothesized the use of local or regional (LRA) would as safe and effective general (GA) for patients undergoing thoracic endovascular aortic repair (TEVAR). Patients who had undergone TEVAR from 2010 to 2020 in Vascular Quality Initiative were analyzed. The exclusion criteria included receipt branched endografts devices extending beyond zone 5. categorized receiving LRA GA, demographics operative details compared using appropriate frequentists tests. Long-term survival was estimated Kaplan-Meier analysis log-rank test. An adjusted performed a Cox proportional hazards model. A total 7285 met inclusion criteria, whom 276 (4%) received LRA. During study period, annual proportion between 3% 4%, no significant change over time (P = .99). older more comorbidities those GA. similar number urgent each group. trend reduced zones covered deployed, shorter procedural durations, blood loss, GA exhibited greater frequency 0 2 proximal landing arm access (Table). No differences found in-hospital mortality (6% vs 6%; P 1.00) composite any complication (21% 23%; .55) groups. incidence stroke (3% 4%; .32), myocardial infarction (1% 1%; 1.00), pneumonia 2%; .78) intensive care unit length stay (2 3 days; < .01) hospital (4 5 .01). median follow-up years, difference unadjusted (hazard ratio, 1.03; 95% confidence interval, 0.78-1.36; .51; Fig). Despite baseline comorbidities, experienced outcomes long-term postoperative lengths stay. should considered frequently select TEVAR.TableBaseline intraoperative characteristics stratified by typeCharacteristicLRA (n 276)GA 7009)P valuePreoperative Age, years74.00 (66.00-82.00)70.00 (60.00-78.00)<.01 Male sex162 (58.7)4113 (58.7)1.00 BMI, kg/m227.11 ± 5.8128.21 6.48.01 Urgent case97 (35.1)2433 (34.7).93 Transfer another facility92 (33.3)2282 (32.6).84 CVD29 (10.5)564 (8.0).18 CAD55 (19.9)1184 (16.9).22 CHF52 (18.8)860 (12.3).00 COPD87 (31.5)1904 (27.2).13 DM44 (15.9)1190 (17.0).71 HTN248 (90.2)6212 (88.9).59 Dialysis12 (4.3)238 (3.4).49 Aortic aneurysm140 (50.7)3150 (44.9).07 Maximum diameter, mm55.75 17.0253.38 16.75.04 dissection50 (18.1)2038 (29.1)<.01 Annual center volume First quartile42 (15.2)724 (10.3).01 Second quartile88 (31.9)1710 (24.4).01 Third quartile109 (39.5)2760 (39.4)1.00 Fourth quartile37 (13.4)1815 (25.9)<.01 Year operation.56 20100 (0.0)6 (0.1) 20116 (2.2)165 (2.4) 201227 (9.8)528 (7.5) 201326 (9.4)798 (11.4) 201432 (11.6)916 (13.1) 201531 (11.2)747 (10.7) 201631 (11.2)648 (9.2) 201734 (12.3)788 (11.2) 201842 (15.2)898 (12.8) 201929 (10.5)902 (12.9) 202018 (6.5)613 (8.7)Intraoperative Percutaneous femoral artery access171 (98.8)3799 (97.0).13 Arm neck access6 (2.2)438 (6.2).20 Largest sheath size, mm18.00 (16.00-19.00)20.00 (18.00-22.00).56 Proximal site Zone 0-24 (2.2)137 (3.1).06 227 (14.7)841 (19.2).12 2-5153 (83.2)3404 (77.7).14 Zones covered, No. ≤2155 (87.6)3722 (86.7).03 3-522 (12.4)570 (13.3).03 Devices 1112 (58.3)2235 (45.9).25 267 (34.9)1972 (40.5).12 313 (6.8)661 (13.6).23 Conversion open1 (0.4)40 (0.6).03 Total procedure time, minutes84.00 (58.75-133.50)112.00 (73.00-180.00).39 Contrast volume, mL82.50 (57.00-132.00)111.00 (72.00-180.00).39 Fluoroscopic minutes11.80 (7.35-19.65)13.20 (8.00-24.30).20 Blood mL50.00 (50.00-150.00)100.00 (50.00-200.00).16 Spinal cord ischemia3 (1.5)90 (1.8).97BMI, Body mass index; CAD, coronary disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary CVD, cerebrovascular DM, diabetes mellitus; anesthesia; HTN, hypertension; LRA, anesthesia.Data presented (interquartile range), (%), mean standard deviation. Open table new tab

برای دانلود باید عضویت طلایی داشته باشید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Local Anesthesia for Percutaneous Thoracic Endovascular Aortic Repair.

BACKGROUND Thoracic endovascular aortic repair (TEVAR) requires large-bore vascular access due to the considerable diameters of the endoprosthesis and delivery device. The preclose technique preceding endograft delivery has opened the door for an evolved access strategy. In addition, treatment under local anesthesia offers the advantage of optimal neuromonitoring. The goal of this study was to ...

متن کامل

open repair versus thoracic endovascular aortic repair in multiple-injured patients: observations from a level-1 trauma center

conclusions due to more sophisticated diagnostic tools and surgical approaches, mortality and morbidity of blunt aortic injuries were significantly reduced over the years compared to thoracic endovascular aortic repair and or over two different time periods. objectives the aim of the present study was to retrospectively evaluate the mortality and morbidity with either treatment option. therefor...

متن کامل

Thoracic endovascular aortic repair (TEVAR)

Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria; Interventional Cardiology, Clı́nico San Carlos University Hospital, Madrid, Spain; Department of Cardiovascular Surgery, Zayed Military Hospital, Abu Dhabi, United Arab Emirates; Department of Cardiothoracic Surgery, University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK; Department of Cardiovascular Surgery,...

متن کامل

Endovascular versus open surgical repair for blunt thoracic aortic injury.

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether patients with acute traumatic thoracic aortic injury have a better outcome with endovascular or open surgical repair. Altogether, 283 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The author, jour...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

ژورنال

عنوان ژورنال: Journal of Vascular Surgery

سال: 2021

ISSN: ['1085-875X', '0741-5214', '1097-6809']

DOI: https://doi.org/10.1016/j.jvs.2021.06.203