Anaesthesia for abdominal vascular surgery
Abstract: Although there are a number of abdominal pathologies requiring vascular surgical intervention, aortic aneurysmal disease is by far the most common and the focus of this article. The most obvious development in this area has been the implementation of a national screening programme for abdominal aortic aneurysm (AAA). Recent changes to try and improve elective mortality figures from around 8% for open repair have been essential to make the screening programme effective. Endovascular aneurysm repair (EVAR) is now the most common technique for elective management. Longer term risks and benefits of endovascular versus open repair is still an area of some controversy. Also controversial is the role of endovascular repair in the emergency ruptured setting. In this article we give an overview of all these areas as well as reviewing current indications for aortic aneurysm surgery. We also include an update of anaesthetic best practices for these patients.
The purpose of this systematic review was to assess the perioperative clinical outcomes in using local/regional anesthesia (LA/RA) or general anesthesia (GA) in patients undergoing endovascular abdominal aortic aneurysm repair. A comprehensive electronic literature search was undertaken from inception to September 2018, identifying all randomized and nonrandomized studies comparing LA/RA versus GA in patients with abdominal aortic aneurysm who underwent endovascular repair. A total of 12,024 patients (n = 1,664 LA/RA, n = 10,360 GA) were analyzed from 12 observational studies included in this analysis.
Given the various types of anesthesia utilized for endovascular abdominal aortic aneurysm repair (EVAR), we sought to determine the effect of anesthesia type in the outcomes of elective EVAR in a large multi-institutional healthcare maintenance organization.
The objective of this study was to compare 30-day postoperative mortality for patients undergoing endovascular repair of ruptured abdominal aortic aneurysm (rAAA) using locoregional vs general anesthesia. Unlike the open approach, endovascular repair of rAAA can be performed using either locoregional or general anesthesia. We hypothesize that mortality after endovascular repair of rAAA is lower when locoregional rather than general anesthesia is used.
CONCLUSIONS: Short-stay EVAR pathways are safe and acceptable to patients. With appropriate selection of motivated patients, successful expedited discharge can be achieved with limited readmissions, thus facilitating increased resource efficiency and cost savings for healthcare providers. PMID: 30994308 [PubMed - as supplied by publisher]
We present the key components of emergency anaesthesia for both OAR and EVAR and describe clinical dilemmas arising at preoperative and intraoperative stages.
Publication date: Available online 21 March 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): John Barrett, Sian JonesAbstractA patient with an abdominal aortic aneurysm can have surgical management through either an open or endovascular approach. The use of an endovascular approach has benefits for the patient by being a less invasive approach with initially lower mortality and morbidity and lower lengths of hospital stay, although longer term outcomes match open techniques. The endovascular technique requires more specialist equipment, including stents and imaging equipment. In the UK they are usually perfor...
Publication date: Available online 19 March 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Alastair Duncan, Adam PichelAbstractThe prevalence of abdominal aortic aneurysm (AAA) and the number of patients undergoing aneurysm repair is increasing. The UK has worked tirelessly to reduce its operative mortality rates for elective open AAA repair with the introduction of a quality improvement programme. Reducing death from ruptured aortic aneurysm has been the focus of the national screening programme. Despite the increased prevalence of disease and intervention, the popularity of open repair has diminished sinc...
Endovascular aneurysm repair (EVAR) is an accepted approach for patients presenting with ruptured abdominal aortic aneurysm (rAAA) and suitable anatomy. The effect of anesthesia modality on mortality outcomes in rAAA has not been well described. Using the Vascular Quality Initiative database, this study compares local anesthesia (LA) vs general anesthesia (GA) in EVAR for rAAA.
Background: The post-hoc subgroup analysis of a large randomized controlled trial, alongside a single case series, has suggested a potential benefit from managing ruptured abdominal aortic aneurysms (rAAA) with endovascular repair (EVAR) using local anaesthesia (LA) rather than general anaesthesia (GA). The uptake and outcomes of this technique in everyday clinical practice are as yet unknown.
Endovascular aneurysm repair (EVAR) is used increasingly in the management of patients with abdominal aortic aneurysms (AAAs), including in the emergency setting for ruptured AAA. The lower mortality among patients undergoing emergency EVAR under local anesthesia (LA) observed in the Immediate Management of Patients with Rupture: Open Versus Endovascular Repair trial has sparked renewed interest in the anesthesia choice for EVAR. This systematic review evaluates the effect of mode of anesthesia on outcomes after EVAR.