Feasibility of endovascular repair of abdominal aortic aneurysms with local anesthesia with intravenous sedation

Purpose: Local anesthesia has been shown to reduce cardiopulmonary mortalit y and morbidity rates in patients who undergo selected peripheral vascular procedures. The efforts to treat abdominal aortic aneurysms (AAAs) with end ovascular techniques have largely been driven by the desire to reduce the m ortality and morbidity rates as compared with those associated with open an eurysm repair. Early results have indicated a modest degree of success in t his goal. The purpose of this study was to investigate the feasibility of e ndovascular repair of AAAs with local anesthesia. Methods: During a 14-month period, 47 patients underwent endovascular repai r of infrarenal AAAs with local anesthesia that was supplemented with intra venous sedation. Anesthetic monitoring was selective on the basis of comorb idities. The patient ages ranged from 48 to 93 years (average age, 74.4 +/- 9.8 years). Of the 47 patients, 55% had significant coronary artery diseas e, 30% had significant chronic obstructive pulmonary disease, and 13% had d iabetes. The average anesthesia grade was 3.1, with 30% of the patients hav ing an average anesthesia grade of 4. The mean aortic aneurysm diameter was 5.77 cm (range, 4.5 to 12.0 cm). All the implanted grafts were bifurcated in design. Results: Endovascular repair of the infrarenal AAA was successful for all 4 7 patients. One patient required the conversion to general anesthesia to fa cilitate the repair of an injured external iliac artery via a retroperitone al approach. The operative mortality rate was 0. No patient had a myocardia l infarction or had other cardiopulmonary complications develop in the peri operative period. The average operative time was 170 minutes, and the avera ge blood loss was 623 mL (range, 100 to 2500 mL). The fluid requirements av eraged 2491 mL. Of the 47 patients, 46 (98%) tolerated oral intake and were ambulatory within 24 hours of graft implantation. The patients were discha rged from the hospital an average of 2.13 days after the procedure, with 87 % of the patients discharged less than 48 hours after the graft implantatio n. Furthermore, at least 30% of the patients could have been discharged on the first postoperative day except for study protocol requirements for comp uted tomographic scanning at 48 hours. Conclusion: This is the first reported series that describes the use of loc al anesthesia for the endovascular repair of infrarenal AAAs. Our prelimina ry results indicate that the endovascular treatment of AAAs with local anes thesia is feasible and can be performed safely in a patient population with significant comorbidities. The significant potential advantages include de creased cardiopulmonary morbidity rates, shorter hospital stays, and lower hospital costs. A definitive evaluation of the benefits of local anesthesia will necessitate a direct comparison with other anesthetic techniques.