Autor:innen:
Aldin Mehmedovic | University Hospital, LMU Munich, Munich, Germany | Germany
Uni. Prof. Dr. med. Nikolaos Tsilimparis | University Hospital, LMU Munich, Munich, Germany | Germany
Priv-Doz. Dr. med Konstantinos Stavroulakis | University Hospital, LMU Munich, Munich, Germany | Germany
Dr. med. Carlota Fernandez Prendes | University Hospital, LMU Munich, Munich, Germany | Germany
Prof. Dr. med. Barbara Rantner | University Hospital, LMU Munich, Munich, Germany | Germany
Dr. med. Jan Stana | University Hospital, LMU Munich, Munich, Germany | Germany
Objective: While regional anesthesia (RA) is well established in carotid endarterectomy procedures, it is not routinely used in cervical debranching procedures. We report herein, to the best of our knowledge, the first case series presenting regional anaesthesia in LSA revascularisation.
Methods: A retrospective analysis from February 2018 until February 2021 was conducted of all consecutive patients undergoing cervical debranching with only carotid-subclavian bypass prior to aortic repair. Primary endpoints included technical success, perioperative mortality, stroke, peripheral neurological lesions, bleeding, wound complication and 30-days re-interventions. Secondary endpoints were mid-term events, including death, patency, reintervention rate and persisting peripheral neurological lesions. Descriptive Statistical analysis was performed with SPSS-26. Mid-to-late term events were calculated using Kaplan-Meier survival analysis. Patency was determined by color-coded duplex sonography (CCD).
Results: 57 patients (mean age 66 ±14.3 year, 69.6% male) were included in the study. In 21 patients (37.5 %) the surgery was performed under RA. Two patients from the RA group (9.5%) had to be converted to GA. Technical success and primary in-hospital graft patency was 100 %. 30-day complication rate was 29.8 % (n=17). One minor stroke (1,8%) was observed in the GA group (p=.625). Peripheral neurological disorder were recorded in 5 patients (8.9 %), (RA group n=1 (1.8 %), GA group n=4 (7.1 %), p=.373). 30-days reintervention rate was 14% (n=8), namely seven bleeding complications (12.2%) (RA group n=1 (1.8 %), GA group n=6 (10.7 %), p=.176) and one seroma evacuation (1.8%) in the RA group. Superficial wound infection incidence was n= 4 (7.1 %) (RA group n = 2 (3.6 %), GA group n=4 (10.7 %), p= .517).
Median follow-up was 14 months (2-31 months). The primary graft patency was 100%. Three patients (5,4%) died during follow-up, unrelated to the cervical debranching. In 4 patients (7.1%) the peripheral neurological lesions persisted during follow-up.
Conclusion: Regional anesthesia for carotid subclavian bypass surgery is a feasible and effective anesthetic procedure which enables an intraoperative neurological monitoring during carotid clamping.