1Maher Hamish, 1Hala Al-Khaffaji, 1Hiba Abdalla, 1Robert Hicks, 1Sreevalsan Kappadath, 1Gabour Libertiny, 1Ganesh Alluvada, 1Séan Matheiken, 1Davis Thomas, 1Yousef Yousef
1Northampton General Hospital, Northampton, United Kingdom
To assess the advantages and disadvantages of emergency endovascular aneurysm repair (eEVAR) under local anaesthesia for the treatment of ruptured abdominal aortic aneurysm (rAAA). This will be determined by observing the effects of eEVAR under LA on short‐term mortality, major complication rates, aneurysm exclusion (specifically endoleaks )
Material(s) and Method(s):
All patients initially allocated to the treatment with EVAR under local Anastasia unless
1.haemodynamicaly unstable patient to have a CT scan.
2. unsuitable anatomy for simple EVAR on the CT scan.
We followed the (Emergency Department Door to Intervention = Less than 90 Minute) role. Restricted fluid resuscitation. Permissive hypotension (to maintain a mental status and target systolic pressure 70-90 mmHg) Arterial and central venous line for resuscitation and monitoring. Prophylactic antibiotic. All EVAR cases attempted with percutaneous approach under LA. Proximal control of the aorta by aortic balloon only considered in circulatory collapse. ITU bed was available for each patient.
1. 15 rAAA cases were managed between 30 /03/2020 – 30/10/2020.
2. 5 cases managed with OSR (unstable, unsuitable anatomy and/or surgeon preference)
3. 10 cases managed with EVAR, 9 under LA, one under GA.
a. 7 percutaneously and 2 with open access.
4. Mortality rate 40% in total.
a. 3 cases from the open group (60%) and exclusively due to cardic and respiratory complications.
b. 3 cases from the EVAR group (30%), 2 of them were re intervention after ruptured EVAR
5. One patient from the EVAR admitted to ITU, 9 to level 1 beds and all the open group admitted to ITU.
6. 2 cases of the EVAR group complicated with Post-operative endoleak (both patients died)
7. Average hospital stay in the EVAR group was 4.5 days and in the open group was 10 days.
Our approach for the management of ruptured AAA with EVAR under local Anastasia was supported by multiple bodies especially the society of the vascular surgeon which resulted in improved outcomes and lower mortality and morbidity rates with shorter hospital stay and decreases the burden on the ICU beds during the COVID-19 pandemic.