Local Anesthesia for Percutaneous Thoracic Endovascular Aortic Repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Anesthesiology

Background:

• Thoracic endovascular aortic repair (TEVAR) necessitates large-bore vascular access for endoprosthesis delivery.
• The preclose technique and local anesthesia offer potential advancements in TEVAR access strategies.
• Local anesthesia facilitates enhanced neuromonitoring during endovascular procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous TEVAR performed under local anesthesia.
• To assess the feasibility of a percutaneous approach for large-bore vascular access in TEVAR.
• To determine the rate of access-related complications and the need for anesthesia conversion.

Main Methods:

• Prospective data collection of elective TEVAR patients from June 2012 to June 2015.
• Utilized a percutaneous approach with the Perclose Proglide device under local anesthesia.
• Analyzed demographics, procedural details, and access-related complications from an endovascular database.

Main Results:

• 37 percutaneous TEVAR procedures were completed in 34 patients under local anesthesia.
• All patients achieved adequate analgesia, with no conversions to general anesthesia.
• A 3% incidence of postprocedural access-related complications was observed, with adequate hemostasis achieved in all cases.

Conclusions:

• Percutaneous TEVAR under local anesthesia is a safe and effective treatment option.
• The percutaneous approach enables local anesthesia, improving neurologic complication recognition.
• This strategy maintains a low risk of access complications despite large-bore access requirements.