Local Versus General Anesthesia in Patients Undergoing Thoracic Endovascular Aortic Repair

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