IF03 - Enhanced early outcomes in EVAR with local anesthesia: findings from the Italian Collaborators for EVAR (ICE) registry.

Friday, June 21, 2024

7:38 AM – 7:48 AM CT

Location: West Building, Level 1, W183c

Submitting & Presenting Author(s)

Davide Esposito, MD (he/him/his)

MD, Vascular Surgeon
San Martino Hospital – University of Genova
Genoa, Liguria, Italy

Co-Author(s)

AF

Aaron Thomas Fargion

University of Florence, Italy
Florence
Walter Dorigo, MD

Associate Professor in Vascular Surgery
University of Florence
Firenze, Toscana, Italy
CM

Caterina Melani

University of Genoa, Italy
FM

Francesca Mauri

University of Insubria, Varese, Italy
SZ

Sergio Zacà

Vascular Surgeon
Department of precision and regenerative medicine and Jonic Area (DiMePre-J), Vascular and Endovascular Surgery, University of Bari School of Medicine “Aldo Moro”, Bari, Italy
Bari, Italy
Gabriele Piffaretti, MD, PhD (he/him/his)

Associate Professor in Vascular Surgery
University of Insubria, Varese, Italy
Varese, Lombardia, Italy
DA

Domenico Angiletta

Vascular Surgery Professor
Department of precision and regenerative medicine and Jonic Area (DiMePre-J), Vascular and Endovascular Surgery, University of Bari School of Medicine “Aldo Moro”, Bari, Italy
Bari, Italy
CP

Carlo Pratesi

University of Florence, Italy
Florence
RP

Raffaele Pulli

University of Florence, Italy
Florence

Senior Author(s)

GP

Giovanni Pratesi

University of Genoa, Italy

Objectives: To assess the influence of anesthesia management, both independently and in conjunction with the choice of femoral access, on initial outcomes following endovascular aneurysm repair (EVAR).

Methods: A retrospective multicenter study was conducted on individuals undergoing standard EVAR at four academic centers. The study compared patients undergoing the procedure with either local or general anesthesia. Additional subanalyses were conducted within each group, specifically focusing on the type of femoral access to further assess its influence on outcomes.

Results: A total of 602 patients underwent standard EVAR, with 272 (45.2%) opting for general anesthesia and 330 (54.8%) for local anesthesia. Patients in the general anesthesia group exhibited higher 30-day major systemic complication rates (25.8% vs. 15.6%, p= .002) and 30-day mortality rates (7.4% vs. 0.6%, p< .001). However, there were no significant differences in terms of reinterventions (3.3% vs. 2.4%, p= .545) and aneurysm-related mortality (1.3% vs. 0.4%, p= .222) at the 1-year mark.
The general anesthesia group also experienced significantly longer total intervention times (124 vs. 89 minutes, p< .001), extended stays in the Intensive Care Unit (ICU) (0.7 vs. 0.4 days, p= .013), and a longer overall hospital length of stay (8.3 vs. 5.3 days, p< .001). In subanalyses, the combination of local anesthesia with bilateral percutaneous femoral access not only improved 30-day outcomes but also led to an additional reduction in total intervention times and ICU stays.

Conclusions: EVAR conducted with local anesthesia demonstrates markedly superior early outcomes in comparison to procedures performed under general anesthesia. The incorporation of percutaneous bilateral femoral access in conjunction with local anesthesia resulted in notable reductions in procedural times and ICU stays, ultimately enhancing early results.