A Systematic Review and Meta-Analysis of Local-Regional versus General Anesthesia for Elective Endovascular Abdominal Aortic Aneurysm Repair

Florencio de Mesquita C.; Queiroz I.; Fontoura M.M.M.; Ruelas M.G.; Tavares A.H.; Barbosa L.M.; Bertolino E.P.; Fernandez M.G.; da Silva Pimentel D., Jr; Mulatti G.C. · Journal of Cardiothoracic and Vascular Anesthesia (2025) · DOI: 10.1053/j.jvca.2025.03.045

Resumen

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment for abdominal aortic aneurysms. The choice between general anesthesia (GA) and local-regional anesthesia (LRA) may impact outcomes, but evidence remains inconsistent. This systematic review and meta-analysis aimed to compare GA and LRA in elective EVAR, focusing on mortality, major adverse cardiovascular events (MACE), endoleaks, intensive care unit admissions, and hospital stay (HS). A comprehensive search of PubMed, Embase, Cochrane Central, and ClinicalTrials.gov included studies from inception to December 2024. Observational studies meeting predefined criteria were analyzed using a fixed-effects model in R, and evidence certainty was assessed using the GRADE framework. This work was registered on PROSPERO (CRD42024547446). Seventeen studies with 91,560 patients were included. LRA was associated with reduced mortality (OR 0.75; 95% CI 0.59-0.97), lower MACE (OR 0.74; 95% CI 0.61-0.90), fewer intensive care unit admissions (OR 0.77; 95% CI 0.73-0.81), fewer type 1 endoleaks (OR 0.84; 95% CI 0.72-0.97), fewer type 2 endoleaks (OR 0.63; 95% CI 0.57-0.70), and shorter HS (–0.38 days; 95% CI –0.46 to –0.30). Sensitivity analyses confirmed most results, but mortality lost significance in some cases. The certainty of evidence ranged from low to very low due to some inconsistencies in studies. LRA may offer better outcomes than GA in elective EVAR, including lower mortality, MACE, and shorter HS. However, further randomized trials are needed to confirm these findings and guide clinical practice.