• P Geisbüsch, B T Katzen, R Machado, J F Benenati, C Pena, and A I Tsoukas.
• Division of Vascular and Interventional Radiology, Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA. philippgeisbuesch@gmx.de
• Eur J Vasc Endovasc Surg. 2011 Oct 1; 42 (4): 467-73.

ObjectiveThe study aimed to analyse and report the results of a 'local anaesthesia first' approach in elective endovascular aneurysm repair (EVAR) patients.Material And MethodsBetween January 2007 and August 2010, a total of 217 continuous patients (187 men, median age 76 years, range 52-94 years) underwent elective EVAR using this approach, with predefined exclusion criteria for local anaesthesia (LA). A retrospective analysis regarding technical feasibility, mortality, complication and endoleak rate was performed. The results are reported as an observational study.ResultsLA was applied in 183 patients (84%), regional anaesthesia (RA) in nine patients (4%) and general anaesthesia (GA) in 25 patients (12%). Anaesthetic conversion from LA to GA was necessary in 14 patients (7.6%). Airway obstruction (n = 4) and persistent coughing (n = 3) were the most common causes for conversion to GA. Thirty-day mortality in the LA group was 2.7%, with 16/183 patients (8.7%) experiencing postoperative complications. All type I endoleaks (n = 5, 2.7%) occurred in patients with LA and challenging aneurysm morphologies.ConclusionsA 'local anaesthesia first' strategy can successfully be applied in 75% of patients undergoing EVAR. The use of LA can impact imaging quality and thus precise endograft placement, which should be considered in patients with challenging aneurysm morphologies.Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

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