Abdominal ve Torasik Aort Anevrizma Olgularında Endovasküler Onarım Sırasındaki Anestezi Yaklaşımının Klinik Sonuçlar Üzerine Etkilerinin Retrospektif Olarak İncelenmesi

Abstract

Zirek Ş. A Retrospective Analysis of the Impact of Anesthetic Techniques on Clinical Outcomes During Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms, Hacettepe University, Department of Anesthesiology and Reanimation, Residency Thesis, Ankara, 2026. The aim of this study was to retrospectively evaluate the effects of different anesthetic techniques used during endovascular aortic repair procedures, including EVAR (Endovascular Aortic Repair) and TEVAR (Thoracic Endovascular Aortic Repair), on perioperative and postoperative clinical outcomes in patients with abdominal and thoracic aortic aneurysms. General anesthesia, regional anesthesia, and local anesthesia with sedation were compared. Patients who underwent endovascular aortic repair at the Vascular Interventional Radiology Unit of Hacettepe University Hospital between January 1, 2004 and September 30, 2024 were screened. A total of 276 patients who underwent EVAR or TEVAR during the study period were screened. Of these, 118 patients were excluded because their anesthesia records were unavailable. The remaining 158 patients with complete anesthesia records were included in the final analysis. The patients were categorized according to the anesthesia technique used: general anesthesia, regional anesthesia, and local anesthesia with sedation. Demographic characteristics, ASA classification, comorbidities, procedural features, intraoperative hemodynamic parameters, administered fluid volume, blood transfusion requirement, antihypertensive and vasopressor use, operation time, length of hospital and intensive care unit stay, laboratory parameters, complications, endoleak, and 30-day mortality were evaluated. The mean age of the patients was 65.45±11.83 years, and 88% were male. EVAR was performed in 74.1% of the patients and TEVAR in 25.9%. Regarding anesthesia technique, 43% of the patients received general anesthesia, 15.8% regional anesthesia, and 41.1% local anesthesia with sedation. Overall, the most common comorbidities were hypertension (70.3%) and coronary artery disease (37.3%), while the most frequent complications were renal complications (6.3%) and bleeding (4.4%). The 30-day mortality rate was 2.5%. In the EVAR group, significant differences were vii observed among anesthesia techniques in mean heart rate, administered fluid volume, and length of hospital stay. Mean heart rate was significantly higher in patients who received regional anesthesia than in those who received local anesthesia with sedation. The amount of administered fluid was significantly higher in patients who received general anesthesia than in those who received local anesthesia with sedation. In addition, the length of hospital stay was significantly longer in EVAR patients receiving regional anesthesia compared with those receiving local anesthesia with sedation. In the TEVAR group, the rate of coronary artery disease was significantly higher in patients who underwent local anesthesia with sedation than in those who received general anesthesia. Furthermore, in TEVAR patients, mean heart rate, operation time, and postoperative creatinine levels were significantly higher in the general anesthesia group than in the local anesthesia with sedation group. In contrast, no significant differences were found between anesthesia techniques in terms of age, weight, sex, ASA class, most comorbidities, smoking status, type of surgery, access site, pathology level, maximum aneurysm diameter, spinal drainage, mean arterial pressure, blood transfusion, antihypertensive and vasopressor use, intensive care unit stay, complication rates, endoleak, or 30-day mortality. Hemoglobin levels significantly decreased in the postoperative period across all anesthesia techniques in both the EVAR and TEVAR groups. In conclusion, this study, which examined approximately 20 years of data, reflects our center’s clinical experience with EVAR and TEVAR procedures. Although the anesthetic approach in endovascular aortic repair appears to affect certain perioperative parameters and selected laboratory outcomes, no clear superiority of any anesthetic technique was demonstrated in terms of major complications, endoleak, or early mortality. These findings emphasize that, when selecting an anesthetic technique for endovascular aortic repair procedures, individualized decision-making based on the type of intervention, anatomical characteristics, comorbidities, and center experience is more important than following a standardized algorithm.