The place of regional anesthesia in vascular surgery: literature review and personal experience

Abstract

Background. Vascular surgery is a high-risk procedure, and most interventions carry a greater than 5% risk of an acute cardiac event. Direct reconstruction of aorto-iliac-femoral segment is associated with a 2.8% perioperative mortality, whereas extra-anatomic bypass has an 8.8% mortality. Arteriosclerosis obliterans is a growing public health concern affecting 8.5 million people in the United States and 200 million people worldwide. Main goals of preoperative assessment of vascular patients are risk stratification and its potential reduction by safe methods of anesthesia. Aim: to compare regional anesthesia during carotid endarterectomy, abdominal aortic aneurysm resection and repair, repair of the lower limb vessels and lower extremity amputation based on the data of the world literature and the choice of safe methods of anesthesia. Materials and methods. The materials are modern world literature, Scopus, Web of Science, MedLine, the Cochrane databases and the latest scientific research. Using the comparative method of analysis, the world literature data were compared with the experience of using regional methods of analgesia at the Kyiv Regional Clinical Hospital. Conclusions. Given the data presented in the article, it can be considered that regional anesthesia is the optimal method for use as monoanesthesia or in combination with general anesthesia in vascular surgery. The use of these methods of anesthesia by an experienced anesthesiologist can decrease length of stay in the hospital and improve the disease course in this rather complex patient population. The decision to use regional techniques should be made by the patient, surgeon, and anesthesiologist after an individualized discussion of the risk-benefit profile for each patient and type of surgery.