LAUSR

Rupture is the most important and catastrophic complication of abdominal aortic aneurysm (AAA). Autopsy studies have proven that >40% of patients with ruptured AAA die before they even arrive at hospital. After the introduction of endovascular aneurysm repair (EVAR) in 1991, it has gained popularity for the treatment of patients with ruptured AAA. In recent years, there has been an increasing debate about the choice of anesthesia type for EVAR. In the meta‐analysis by Lei et al., in‐hospital and 30‐day outcomes of local anesthesia (LA) versus general anesthesia (GA) in patients undergoing EVAR for ruptured AAA were assessed. They found that LA was associated with a lower mortality rate in the perioperative period than GA as primary outcome. However, there was no significant difference between the two anesthesia types in terms of complications, ICU admissions, postoperative morbidity of pneumonia, myocardial infarction, leg ischemia, and wound complication as secondary outcomes. The meta‐analysis has a few limitations. First, retrospective studies comprised the majority. Second, only two studies included a described specific complication morbidity as secondary outcome. Third, the details of anesthesia protocols were lacking. Fourth, details about major complications such as abdominal compartment syndrome, ischemic colitis, and endoleak were not included. Despite those limitations, the most highlighting result of the meta‐analysis is that the perioperative mortality of stable patients with ruptured AAA undergoing EVAR under LA was significantly lower than that of GA. Notably, the vascular anatomy and complexity of the aneurysm, working conditions in which the patient must remain immobilized, risk of motion artifacts, providing rapid opportunity for conversion to open surgery, and experience of the relevant center along with the physicians are the crucial factors guiding the choice of GA or LA. Based on these evidence, LA seems to be advantageous over GA in well‐selected group of patients at the experiences centers with the availability to convert to GA in unexpected circumstances. Further clinical studies are needed to clarify the potential debate raised by this meta‐analysis.