Mini-endovascular aneurysm repair: a minimalist approach for a minimally invasive procedure

Introduction
Abdominal aortic aneurysms represent the majority of all aneurysms of the aorta. Endovascular aneurysm repair (EVAR) is an alternative procedure to surgical repair. Although general and regional anaesthesia are frequently used during EVAR procedures, local anaesthesia has become one of the anaesthesia options for which there is increasing experience.

Aim
We reported our EVAR cases in which we routinely used femoral local anaesthesia.

Material and methods
Between August 2016 and June 2020, the EVAR procedure was applied to 22 infrarenal abdominal aortic aneurysm patients under femoral local anaesthesia. Open femoral artery access through a groin incision was used in all patients. Patients were followed up for graft- and wound-related complications.

Results
The mean age of the patients was 72.59 ±6.6 years (min: 60, max: 84). Mean aneurysm sac diameter was 61.04 ±8.76 mm. Bifurcated stent graft was used in 21 (95.5%) patients. An aorto-uni-iliac stent graft was used for 1 (4.5%) patient due to contralateral total iliac occlusion. Endoleak was observed in 6 patients. In-hospital mortality was observed in 2 patients; both cases were ruptured with haemodynamic instability (9%). Revision in the groin area was performed in 3 (13.6%) patients due to local wound complications.

Conclusions
Although the EVAR procedure has been described as a safer and more easily applicable alternative to surgical repair, it is disadvantageous in terms of increasing treatment costs. Anaesthesia preference and incision size with a more minimalist approach can reduce the length of hospital stay and minimize the complications that may occur after the procedure, resulting in decreased costs.