Endovascular Abdominal Aortic Aneurysm Repair under General Anesthesia Does Not Decrease Perioperative Myocardial Ischemic Events Compared with Open Repair

Objectives: Endovascular abdominal aortic aneurysm repair (EVAR) is a common procedure for abdominal aortic aneurysm (AAA), based on minimal invasiveness compared with open surgical repair (OSR). However, general anesthesia can cause considerable perturbations in patients with AAA undergoing operative repair. The aim of this study was to compare the incidence of myocardial ischemic events in association with hemodynamic changes during EVAR and OSR under general anesthesia. Methods: We retrospectively reviewed the anesthetic and medical records of patients who underwent elective abdominal aortic aneurysm repair. ST segment changes on electrocardiography and hemodynamic changes were reviewed by the attending physicians. Results: Among 120 patients, EVAR and OSR were performed in 81 and 39 patients, respectively. There were no significant differences in preoperative morbidity between the two groups. The amount of estimated blood loss was significantly lower in EVAR than OSR. The incidence of ST segment changes in the two groups (EVAR: 16%, OSR: 23%) was not statistically different. ST segment changes occurred mainly postoperatively at resolution of anesthesia in EVAR, compared with intraoperatively in OSR. ST segment changes were mostly accompanied by tachycardia in EVAR patients, whereas they were associated with hypotension in OSR. Conclusion: Our results demonstrated a comparable incidence of perioperative ST segment changes under general anesthesia in EVAR and OSR. Patients who undergo EVAR and develop tachycardia are at risk of myocardial ischemia at resolution of anesthesia.