Duplex Ultrasound Criteria for Renal Artery In-Stent Restenosis

Abstract

Methods: A retrospective review was conducted of all TEVAR cases performed at Trillium Health Centre (2011)(2012)(2013)(2014)(2015). These cases were analyzed with respect to the type of anesthesia and the use of CSF drainage.Results: This retrospective case series identified 29 patients, of whom 2 were excluded for use of spinal anesthesia; TEVAR was performed in 12 patients under general anesthesia and in 15 patients under local anesthesia. Patients undergoing local anesthesia had significantly more comorbidities, with 80% (n ¼ 12) having three or more comorbidities relative to 42% (n ¼ 5) in the general anesthesia group. There were no significant differences in aneurysm size or extent of aortic coverage between the two groups. Spinal drains were placed preoperatively in 33% (n ¼ 5) of patients with the procedure performed under local anesthesia and in 92% (n ¼ 11) of patients with the procedure performed under general anesthesia. One patient in the local anesthesia group with coverage of the left subclavian artery developed a delayed global paralysis on postoperative day 12 necessitating a carotid-subclavian bypass. Other 30-day TEVAR-related complications included one non-ST-segment elevation myocardial infarction and one pneumonia in the general anesthesia group and one transient ischemic attack, one non-ST-segment elevation myocardial infarction, and one wound infection in the local anesthesia group. There was a trend toward shorter length of stay in the local anesthesia group at 5.5 days vs 8.5 days with general anesthesia.Conclusions: In this study, there was no increased risk of paralysis in patients in whom the procedure was performed under local anesthesia without CSF drainage; however, further study is required to definitively assess the risk of paralysis in this population of patients. The use of local anesthesia in this setting enables continuous intraoperative assessment of neurologic function and allows appropriate and timely intervention if required.