Inguinal field block for femoral artery exposure during endovascular aneurysm repair

Abstract

Purpose: To analyze the feasibility and outcomes of an inguinal field block (IFB) for femoral artery exposure in patients undergoing elective endovascular aneurysm repair (EVAR).

Methods: Between January 2004 and June 2012, 784 patients (597 men; mean age 76 years) underwent elective EVAR via surgical cutdown to the common femoral arteries. The data from these procedures were retrospectively analyzed to determine the technical feasibility of IFB, need for conversion to general anesthesia, mortality, and complication rate.

Results: IFB was successfully performed in 768 (97.9%) patients. Conversion from IFB to general anesthesia was necessary in 11 (1.4%) patients owing to patient discomfort (n=3, 0.4%), anxiety (n=5, 0.6%), and persistent patient movement (n=3, 0.4%). The remaining 5 (0.7%) patients underwent EVAR under general anesthesia because they refused IFB. Technical success of EVAR was 99.7%; the mean operation time was 84 minutes and the radiation time was 13 minutes. The mean hospital stay was 3.7 days; no patient required intensive care. At 6 months, there were no reports of local/systemic complications related to IFB, such as infection, seroma, hematoma, nerve injury, or allergic/toxic reactions.

Conclusion: Our study demonstrated that performing EVAR with femoral cutdown under IFB is a feasible, safe, and effective surgical and anesthetic combination, with very little need for conversion to general anesthesia.