Comparison of Local and General Anesthesia on 30-Day Outcomes of Emergency Infrainguinal Endovascular Revascularization for Patients with Chronic Limb-Threatening Ischemia.

Abstract

BackgroundInfrainguinal endovascular interventions can be the first-choice treatment for suitable patients with peripheral artery disease (PAD). However, the choice of anesthesia for infrainguinal endovascular procedures, particularly in emergency situations, remains underexplored. This study aimed to conduct a retrospective analysis based on a multi-institutional nationwide registry to compare the 30-day outcomes of patients with chronic limb-threatening ischemia (CLTI) who received either local anesthesia (LA) or general anesthesia (GA) during emergency infrainguinal endovascular interventions.MethodsPatients who underwent emergency infrainguinal endovascular revascularization for CLTI (tissue loss or rest pain) were selected from the ACS-NSQIP database from 2012-2022. Multivariable logistic regression was used to compare 30-day outcomes between patients under GA and LA, where demographics, baseline characteristics, and symptomatology were adjusted.ResultsAmong 703 patients, 292 (41.54%) were under LA, and 411 (58.46%) were under GA. Patients under LA had lower bleeding requiring transfusion (aOR = 0.428, 95 CI = 0.281-0.653, P < 0.01), lower postoperative wound complications (aOR = 0.289, 95 CI = 0.137-0.612, P < 0.01), and shorter operative time (102.00 ± 72.38 vs 150.70 ± 105.40 minutes, P < 0.01). All other 30-day outcomes, including mortality, organ system complications, and limb-specific outcomes, were comparable between patients under LA and GA.ConclusionLA and GA can be considered equivalent options for eligible CLTI patients undergoing emergency infrainguinal endovascular revascularization, with close monitoring of wound and bleeding complications recommended for GA patients. Further studies are necessary to evaluate long-term outcomes in these patients.