Local Anesthesia Is Associated With Lower Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysm

ObjectivesEndovascular Aortic Repair (EVAR) is the preferred treatment for symptomatic and asymptomatic abdominal aortic aneurysms (AAA) meeting anatomical criteria. This study compares outcomes of EVAR for symptomatic AAA (ruptured and non-ruptured) performed under general anesthesia (GA) vs. local anesthesia (LA).MethodsUsing the Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) registry (2003-2021), patients undergoing EVAR were divided into Group I (symptomatic, non-ruptured AAA) and Group II (ruptured AAA), then subdivided by anesthesia type: Ia (LA), Ib (GA), IIa (LA), IIb (GA). Primary outcomes were 30-day and in-hospital mortality, length of stay (LOS), and discharge disposition. Secondary outcomes included ICU stay and systemic complications.ResultsAmong 8710 patients (Group I: n = 5310; Group II: n = 3400), LA was used in 6.2% of symptomatic, non-ruptured cases (Ia) and 13.4% of ruptured cases (IIa). Group Ia patients were older, White, Medicare-insured, and had higher CHF prevalence compared to group Ib. Group IIa patients had higher hospital transfer rates and family AAA history compared to IIb. In ruptured AAA, LA was associated with significantly lower mortality compared to GA (30-day: 12.3% vs 20.5%, OR 0.50, <i>P</i> < 0.001; in-hospital: 10.3% vs 19.1%, OR 0.42, <i>P</i> < 0.001). Secondary outcomes favored LA, including shorter ICU stay (3.6 ± 5.2 vs 4.9 ± 7.2 days), lower dysrhythmia (9.0% vs 12.4%), and stroke rates (0.9% vs 2.4%). High-volume hospitals performed more EVAR under LA for ruptured AAA.ConclusionsFor ruptured AAA, EVAR under LA is associated with significantly lower mortality and reduced complications, supporting its use particularly in high-volume centers.