Open surgical treatment of abdominal aortic aneurysms causes considerable nociceptive stimuli and hemodynamic alterations. Transvascular insertion of endoluminal stent-grafts is a new, less invasive alternative. Yet, it is performed almost exclusively under general anesthesia [1]. We report our experience with various anesthetic techniques for this novel procedure. Methods: With IRB approval and informed consent, 26 patients (age 56-93 years; ASA physical status III or IV) with infrarenal aortic aneurysms underwent, in an open, non-randomized fashion, 31 endoluminal stenting procedures under general endotracheal (GEA; n=8), epidural (EDA; n=13) or local anesthesia with sedation (monitored anesthesia care, MAC; n=10). Intraanesthetic hemodynamics, interventions, parameters of postoperative (p.op.) oxygenation and systemic inflammatory response, and perioperative complications were analyzed retrospectively, and compared between anesthetic techniques (median [range]; non-parametric and contingency Table analysis. Results: Groups' demographics and preoperative cardiac risk profiles were similar. With growing experience of the interventional team, GEA was replaced by EDA or MAC. There was no conversion to open aortic surgery, perioperative myocardial infarction or death in any of the groups. Intraoperative (i.op.) hypotension (p<0.001), use of pressor drugs (p<0.02), of pulmonary artery catheters and p.op. intensive care beds was most frequent in GEA, and least so in MAC. Groups did not differ with regard to incidence and duration of i.op. hypertension, brady-or tachycardia, arterial oxygen desaturation, use of vasopressors, antihypertensive medication or colloid volume replacement. About 90% of the patients developed a p.op. systemic inflammatory response, regardless of anesthesia technique (GEA: 7/8; EDA: 12/13; MAC: 7/9; n.s). Within 2 p.op. days, temperature peaked at 38.4 [degree sign]C [36.4-39.4], white cell count at 10.6 /[micro sign]L [5.5-26.8], and C-reactive protein at 134 mg/L [20-280] (n.s. between groups). Transient arterial desaturation was recorded in 91% (21/23) of p.op. patients (n.s. between groups). After 4/31 procedures (13%), hyperpyrexia was accompanied by cardiac events (intermittent tachyarrhythmia, n=3; angina pectoris, n=1; recurrent VT, n=1). Discussion: In practice settings with experience and low conversion rate to open surgery, EDA or MAC provided by professional anesthesia care teams are feasible alternatives to GEA for non-emergent transfemoral stent-graft repair of the abdominal aorta. Ready-to-use invasive monitoring, emergency GEA and transfusion equipment, and close postoperative observation are required with either method. The inflammatory "postimplantation syndrome" [1] occurs independently of the anesthetic technique. In patients with limited cardiovascular or pulmonary reserves, it may precipitate postoperative complications.