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Observational Study
. 2021 Feb;69(2):267-273.
doi: 10.1007/s11748-020-01452-w. Epub 2020 Jul 28.

Safety and efficacy of the percutaneous thoracic endovascular repair with regional anesthesia

Satoru Domoto  1 , Takashi Azuma  2 , Keisuke Nakazawa  3 , Yoshihiko Yokoi  2 , Minako Hayakawa  2 , Akiko Yamagata  2 , Shogo Isomura  2 , Minoru Nomura  3 , Hiroshi Niinami  2
Affiliations
Observational Study

Safety and efficacy of the percutaneous thoracic endovascular repair with regional anesthesia

Satoru Domoto et al. Gen Thorac Cardiovasc Surg. 2021 Feb.

Abstract

Objectives: Thoracic endovascular aortic repair (TEVAR) is typically performed with general anesthesia (GA) and surgical cutdown (G-TEVAR). As the latest generation of TEVAR delivery systems are smaller, we introduced percutaneous TEVAR with regional anesthesia (RA) (R-TEVAR) and an arteriotomy closure device. In this study, we compare the safety and efficacy of R-TEVAR to that of the G-TEVAR.

Methods: This single-center observational study included consecutive patients who underwent either G-TEVAR between January 2015 and October 2018 (33 patients) or R-TEVAR (41 patients) between January 2018 and April 2020. RA was achieved using an ultrasound-guided nerve block.

Results: The mean outer diameter of the delivery device was significantly smaller in R-TEVAR (18.5 vs. 22.7 Fr; p < 0.01) and the time from arriving into the operating room to beginning of surgery (34.1 vs. 68.5 min; p < 0.01), procedural time (46.4 vs. 103.6 min; p < 0.01), and operating room stay time (108.3 vs. 194.6 min; p < 0.01) were significantly shorter. The mean rate of change in blood pressure was significantly lower in the R-TEVAR group (7.7% vs. 32.2%; p < 0.01). One case of spinal cord ischemia occurred in the G-TEVAR group (0% vs. 3.0%; p = 0.262) and one case of inadequate hemostasis and conversion to surgical cutdown without GA occurred in the R-TEVAR group (2.4% vs. 0%; p = 0.366).

Conclusions: The R-TEVAR is safe and minimally invasive. Further, RA may provide additional benefits of mean blood pressure stability and early recognition of neurologic complications.

Keywords: Percutaneous thoracic endovascular repair; Regional anesthesia.

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