EPIDURAL VERSUS GENERAL-ANESTHESIA - DOES ANESTHETIC MANAGEMENT INFLUENCE EARLY INFRAINGUINAL GRAFT THROMBOSIS

A few contemporary reports have suggested that the use of epidural ane sthesia may favorably influence early graft patency in patients underg oing infrainguinal revascularization. In order to test this hypothesis , we have retrospectively reviewed our experience with 303 primary fem oropopliteal-tibial bypass procedures in 294 patients from January 198 9 through June 1994. A total of 145 of these operations were done unde repidural anesthesia (EA) and 158 under general anesthesia (GA); the d emographic profiles for the patients in both of these groups were near ly identical. Thirteen patients (4.2%) died during the perioperative p eriod (EA 3.4%, GA 5.0%; p = 0.48). Early graft thrombosis occurred in 35 patients (12%) during the same hospital admission (EA 14%, GA 9.4% ; p = 0.28). There were no significant differences in the graft thromb osis rates for EA and GA with respect to surgical indications (claudic ation versus limb salvage), graft materials (vein versus synthetic), o r the extent of revascularization (popliteal versus crural). Most graf t failures appeared to be related to such conventional factors as disa dvantaged outflow vessels and/or specific technical complications. The refore, we conclude that the choice between EA and GA should continue to be made selectively on the basis of traditional anesthetic consider ations.