SIR 2024
Arterial Interventions and Peripheral Arterial Disease (PAD)
Nikhil Gowda, MD
Resident
Department of Interventional Radiology, The George Washington University
Financial relationships: Full list of relationships is listed on the CME information page.
Ryan Lee, MD, MBA
Resident
Department of Anesthesiology, Rutgers New Jersey Medical School
Disclosure information not submitted.
Andrew Ko, MD
Resident
Department of Interventional Radiology, The George Washington University
Disclosure information not submitted.
Shivam Patel, DO
Resident
Department of Anesthesiology, Rutgers New Jersey Medical School
Disclosure information not submitted.
Ryan Daoud, MD
Resident
Department of Anesthesiology, Rutgers New Jersey Medical School
Disclosure information not submitted.
Eric Heinz, MD, PhD
Associate Professor of Anesthesiology and Critical Care Medicine
Department of Anesthesiology and Critical Care Medicine, The George Washington University
Disclosure information not submitted.
CEM generated matched cohorts for GA (n = 9,147) and MAC/IV (n = 757) that were controlled for differences in demographics and pre-operative characteristics. Compared to their MAC/IV counterparts, the CEM-matched GA patients had significantly longer operative times (p < 0.001) and remained hospitalized for longer post-operatively (p = 0.001). In aggregate, the GA cohort demonstrated increased risk of having any tracked complication (RR = 1.32, p = 0.008), any major complication (RR = 1.31, p = 0.043), or any minor complication (RR = 1.48, p=0.008). The GA cohort also demonstrated significantly greater rates of postoperative renal complications (RR = 5.39, p = 0.015) and blood transfusions (RR = 1.43, p = 0.047) compared to the MAC/IV sedation cohort.
Conclusion: Controlling for differences in patient characteristics, patients who underwent endovascular repair for non-ruptured infrarenal abdominal aortic aneurysm with GA demonstrated increased overall morbidity compared to patients treated with MAC/IV. While GA may remain preferred for more complex repairs requiring longer operative duration, MAC/IV should be strongly considered as an alternative in the appropriate clinical setting. Future prospective studies are indicated to further analyze the impact of anesthetic technique on outcomes following endovascular procedures such as EVAR.