The effects of anesthesia types on early postoperative results in elective endovascular repair of aortic aneurysms

Objectives: This study aims to investigate the effects of anesthesia types on early postoperative outcomes in patients treated with endovascular aneurysm repair (EVAR).

Patients and methods: Between January 2012 and January 2018, a total of 134 patients (10 females, 124 males; mean age 69.1±7.9 years; range, 52 to 85 years) who were operated under local-locoregional or general anesthesia for abdominal aortic aneurysms were retrospectively analyzed. Type of anesthesia was chosen individually, according to the patient suitability, aneurysm anatomy, and technical difficulty. Early mortality was defined as mortality observed within 30 days after the operation.

Results: Of the patients, 42 were operated under local-locoregional anesthesia and 92 were operated under general anesthesia. There was no conversion to general anesthesia. The mean procedural time was 133.2±30.4 min in the local-locoregional group and 156.4±53.4 min in the general anesthesia group (p=0.012). In the early postoperative period, there was one (1.1%) early mortality. Four patients (4.3%) developed renal impairment. One patient (1.1%) in the general anesthesia group had myocardial infarction after the procedure. In the
local-locoregional group, the mean length of intensive care unit (ICU) stay was 8.5±6.4 h and the mean length of hospital stay (LOS) was 2.9±1.5 days. In the general anesthesia group, the mean length of ICU stay was 9.6±0.4 h and the mean LOS was 3.1±2.9 days, indicating a statistically significant difference between the groups in terms of the ICU stay (p=0.013). The mean amount of radio-opaque solution was also statistically significant between the groups (p=0.01). 

Conclusion: Endograft types, the American Society of Anesthesiologists (ASA) classification, patient’s emotional health, aneurysm anatomy, and having a high risk for conversion to open surgery are the key factors for choosing the most appropriate anesthesia type. Based on our study results, type of anesthesia does not affect the early results, although local anesthesia is more suitable and most commonly used in unibody grafts and high-risk patients.