Vascular & Endovascular Surgery, University of Miami & Miami VAMC, Miami, FL, USA.
Vascular. 2022 Jun;30(3):418-426. doi: 10.1177/17085381211012908. Epub 2021 May 3.
To report our experience and compare the results of percutaneous endovascular aortic aneurysm repair (PEVAR) performed under monitored anesthesia care (MAC) to PEVAR under general anesthesia (GA).
A retrospective review of patients who underwent non-emergency endovascular abdominal aortic aneurysm repair (EVAR) was completed. Patients were excluded if they had a complex repair, including fenestrated, branched, or parallel endografting. Demographics, operative data, 30-day mortality/morbidity and postoperative outcomes were analyzed.
A total of 159 patients were identified with a median age of 69. 115 patients had PEVAR, 45 (39.1%) PEVAR MAC and 70 (60.9%) PEVAR GA. PEVAR MAC compared to PEVAR GA had decreased operative time (106 vs. 134 min, < 0.001), time in the operating room (163 vs. 245 min, = 0.016), and estimated blood loss (EBL) (115 vs. 176 mL = 0.012). There was no statistically significant difference in the hospital length of stay (LOS) (1.9 vs. 2.7 days, = 0.133), and post-operative complications including pulmonary (2.2 vs. 2.9%, = 0.835). Forty-four patients had EVAR with a femoral cutdown (FC), including 14 PEVAR conversions. PEVAR conversion was associated with higher EBL (543 vs. 323 mL, = 0.03), operative time (230 vs. 178 min, = 0.01), and operating room time (307 vs. 275 min, = 0.01) compared to planned EVAR with FC.
PEVAR under MAC is associated with shorter time in the operating room compared to PEVAR under GA. PEVAR under MAC does however not decrease overall morbidities, including postoperative pulmonary complications.
报告我们的经验，并比较在监测麻醉下进行的经皮腔内主动脉瘤修复术（PEVAR）与全身麻醉下进行的 PEVAR 的结果。
回顾性分析了非紧急血管内腹主动脉瘤修复术（EVAR）的患者。排除复杂修复患者，包括开窗、分支或平行内支架。分析了患者的人口统计学资料、手术数据、30 天死亡率/发病率和术后结果。
共确定了 159 例患者，中位年龄为 69 岁。115 例患者行 PEVAR，45 例（39.1%）行 PEVAR MAC，70 例（60.9%）行 PEVAR GA。与 PEVAR GA 相比，PEVAR MAC 的手术时间（106 分钟对 134 分钟， < 0.001）、手术室时间（163 分钟对 245 分钟， = 0.016）和估计失血量（EBL）（115 毫升对 176 毫升， = 0.012）均减少。住院时间（LOS）（1.9 天对 2.7 天， = 0.133）和术后并发症（包括肺部并发症，2.2%对 2.9%， = 0.835）差异无统计学意义。44 例患者行股动脉切开术（FC）EVAR，其中 14 例 PEVAR 转为开放手术。PEVAR 转为开放手术与更高的 EBL（543 毫升对 323 毫升， = 0.03）、手术时间（230 分钟对 178 分钟， = 0.01）和手术室时间（307 分钟对 275 分钟， = 0.01）相关。
MAC 下的 PEVAR 与 GA 下的 PEVAR 相比，手术时间更短。然而，MAC 下的 PEVAR 并不能降低术后肺部并发症等总体发病率。
