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Abstract：
Endovascular aneurysm repair (EVAR) is used increasingly in the management of patients with abdominal aortic aneurysms (AAAs), including in the emergency setting for ruptured AAA. The lower mortality among patients undergoing emergency EVAR under local anesthesia (LA) observed in the Immediate Management of Patients with Rupture: Open Versus Endovascular Repair trial has sparked renewed interest in the anesthesia choice for EVAR. This systematic review evaluates the effect of mode of anesthesia on outcomes after EVAR.
The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary outcome was in-hospital/30-day mortality, and both emergency and elective EVAR were included. The relative risk of death was estimated for each individual study without adjustment for potential confounding factors.
Hospitals.
A total of 39,744 patients from 22 nonrandomized studies were included in the analysis.
None.
Sixteen studies in 23,202 patients compared LA to general anesthesia (GA) and reported in-hospital/30-day mortality. The unadjusted risk of death after emergency EVAR with LA was lower than with GA. Trends in elective surgery were less clear.
There is some evidence across both emergency and elective settings to suggest that mode of anesthesia may be associated with improved outcomes. In particular, LA appears to have a positive effect on outcome after emergency EVAR. Because of the lack of randomized trial data, a significant risk of confounding remains. The optimal mode of anesthesia for EVAR should be investigated further and the reasons why particular anesthesia techniques are chosen for particular patients identified.
The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary outcome was in-hospital/30-day mortality, and both emergency and elective EVAR were included. The relative risk of death was estimated for each individual study without adjustment for potential confounding factors.
Hospitals.
A total of 39,744 patients from 22 nonrandomized studies were included in the analysis.
None.
Sixteen studies in 23,202 patients compared LA to general anesthesia (GA) and reported in-hospital/30-day mortality. The unadjusted risk of death after emergency EVAR with LA was lower than with GA. Trends in elective surgery were less clear.
There is some evidence across both emergency and elective settings to suggest that mode of anesthesia may be associated with improved outcomes. In particular, LA appears to have a positive effect on outcome after emergency EVAR. Because of the lack of randomized trial data, a significant risk of confounding remains. The optimal mode of anesthesia for EVAR should be investigated further and the reasons why particular anesthesia techniques are chosen for particular patients identified.
摘要：
血管内动脉瘤修复术（EVAR）越来越多地用于腹主动脉瘤（AAAs）患者的管理，包括在AAA破裂的紧急设置中。在“破裂患者的即时管理：开放与血管内修复试验”中观察到的局部麻醉（LA）下接受紧急EVAR的患者死亡率较低，这引发了人们对EVAR麻醉选择的新兴趣。本系统评价麻醉方式对EVAR术后预后的影响。
根据系统评价的首选报告项目和荟萃分析指南进行综述。主要结果是住院/30天死亡率，包括紧急和选择性EVAR。估计每个单独研究的相对死亡风险，而不调整潜在的混杂因素。
医院。
共有来自22项非随机研究的39,744名患者纳入分析。
无。
在23,202名患者中进行了16项研究，将LA与全身麻醉（GA）进行了比较，并报告了住院/30天死亡率。LA急诊EVAR后未调整的死亡风险低于GA。择期手术的趋势不太清楚。
在急诊和择期设置中都有一些证据表明麻醉模式可能与改善预后相关。特别是,LA似乎对紧急EVAR后的结果有积极影响。由于缺乏随机试验数据，混淆的重大风险仍然存在。应进一步研究EVAR的最佳麻醉模式，并确定为特定患者选择特定麻醉技术的原因。
根据系统评价的首选报告项目和荟萃分析指南进行综述。主要结果是住院/30天死亡率，包括紧急和选择性EVAR。估计每个单独研究的相对死亡风险，而不调整潜在的混杂因素。
医院。
共有来自22项非随机研究的39,744名患者纳入分析。
无。
在23,202名患者中进行了16项研究，将LA与全身麻醉（GA）进行了比较，并报告了住院/30天死亡率。LA急诊EVAR后未调整的死亡风险低于GA。择期手术的趋势不太清楚。
在急诊和择期设置中都有一些证据表明麻醉模式可能与改善预后相关。特别是,LA似乎对紧急EVAR后的结果有积极影响。由于缺乏随机试验数据，混淆的重大风险仍然存在。应进一步研究EVAR的最佳麻醉模式，并确定为特定患者选择特定麻醉技术的原因。
