Local Anesthesia for Percutaneous Thoracic Endovascular Aortic Repair

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) requires large-bore vascular access due to the considerable diameters of the endoprosthesis and delivery device. The preclose technique preceding endograft delivery has opened the door for an evolved access strategy. In addition, treatment under local anesthesia offers the advantage of optimal neuromonitoring. The goal of this study was to analyze the efficacy and safety of percutaneous TEVAR under local anesthesia.

Methods: All patients undergoing TEVAR in an elective setting at the Antwerp University Hospital between June 2012 and June 2015 were prospectively entered into an endovascular database. This database was queried for demographics, procedural details, and access-related complications. All patients underwent a percutaneous approach with the Perclose Proglide under local anesthesia.

Results: This review identified 34 patients in whom 37 percutaneous TEVAR procedures were completed under local anesthesia. All patients experienced adequate analgesia, and no conversions to general anesthesia were implemented. The mean size of the arteriotomy was 23.8 ± 1.3 French (F). The number of Proglide deployments was 80, with an 8% rate of failure on deployment. There were no conversions to surgical cutdown, and adequate hemostasis was obtained in all procedures. The incidence of postprocedural access-related complications was 3%.

Conclusion: Local anesthesia for percutaneous TEVAR can be performed safely and effectively. The percutaneous approach facilitates local anesthesia, which provides the added benefit of early recognition of neurologic complications while maintaining a low risk of access-related complications despite the need for large-bore vascular access.

Key Words

Thoracic endovascular aortic repair - Percutaneous - Local anesthesia

• References

• 1 Nelson PR, Kracjer Z, Kansal N, Rao V, Bianchi C, Hashemi H. , et al. A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial). J Vasc Surg 2014; 59: 1181-1193 . DOI: 10.1016/j.jvs.2013.10.101
• 2 Torsello GB, Kasprzak B, Klenk E, Tessarek J, Osada N, Torsello GF. Endovascular suture versus cutdown for endovascular aneurysm repair: a prospective randomized pilot study. J Vasc Surg 2003; 38: 78-82 . DOI: 10.1016/S0741-5214(02)75454-2
• 3 Malkawi AH, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM. Percutaneous access for endovascular aneurysm repair: a systematic review. Eur J Endovasc Surg 2010; 39: 676-682 . DOI: 10.1016/j.ejvs.2010.02.001
• 4 Etezadi V, Katzen BT, Naiem A, Johar A, Wong S, Fuller J. , et al. Percutaneous suture mediated closure versus surgical arteriotomy in endovascular aortic aneurysm repair. J Vasc Interv Radiol 2011; 22: 142-147 . DOI: 10.1016/j.jvir.2010.10.008
• 5 Mousa AY, Campbell JE, Broce M, Abu-Halimah S, Stone PA, Hass SM. , et al. Predictors of percutaneous access failure requiring open femoral surgical conversion during endovascular aortic aneurysm repair. J Vasc Surg 2013; 58: 1213-1219 . DOI: 10.1016/j.jvs.2013.04.065
• 6 Bechara CF, Barshes NR, Pisimisis G, Chen H, Pak T, Lin PH. , et al. Predicting the learning curve and failures of total percutaneous aortic aneurysm repair. J Vasc Surg 2013; 57: 72-76 . DOI: 10.1016/j.jvs.2012.07.050
• 7 Manunga JM, Gloviczki P, Oderich GS, Kalra M, Duncan AA, Fleming MD. , et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2013; 58: 1208-1212 . DOI: 10.1016/j.jvs.2013.05.028
• 8 Zakko J, Scali S, Beck AW, Klodell CK, Beaver TM, Martin TD. , et al. Percutaneous thoracic endovascular aortic repair is not contraindicated in obese patients. J Vasc Surg 2014; 60: 921-928 . DOI: 10.1016/j.jvs.2014.04.051
• 9 Bensley RP, Hurks R, Huang Z, Pomposelli F, Hamdan A, Wyers M. , et al. Ultrasound-guided percutaneous endovascular aneurysm repair success is predicted by access vessel diameter. J Vasc Surg 2012; 55: 1554-1561 . DOI: 10.1016/j.jvs.2011.12.042
• 10 Arthurs ZM, Starnes BW, Sohn VY, Singh N, Andersen CA. Ultrasound-guided access improves rate of access-related complications for totally percutaneous aortic aneurysm repair. Ann Vasc Surg 2008; 22: 736-741 . DOI: 10.1016/j.avsg.2008.06.003
• 11 Chaikof EL, Blankensteijn JD, Harris PL, White GH, Zarins CK, Bernhard VM. , et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 2002; 35: 1048-1060 . DOI: 10.1067/mva.2002.123763
• 12 Lee WA, Brown MP, Nelson PR, Huber TS. Total percutaneous access for endovascular aortic aneurysm repair (“Preclose” technique). J Vasc Surg 2007; 45: 1095-1101 . DOI: 10.1016/j.jvs.2007.01.050
• 13 van Dorp M, Ruyssers M, Amajoud Z, Lauwers P, Van Schil PE, Hendriks JM. Preclose percutaneous endurant endografting with the Proglide device: a safe and feasible combination. Acta Chir Belg 2015; 115: 219-223 . DOI: 10.1080/00015458.2015.11681100
• 14 Verhoeven EL, Cinà CS, Tielliu IF, Zeebregts CJ, Prins TR, Eindhoven GB. , et al. Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2005; 42: 402-409 . DOI: 10.1016/j.jvs.2005.05.047