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Abstract

Endovascular Aneurysm Repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms by offering a minimally invasive alternative to open surgical repair, typically associated with reduced perioperative morbidity and faster recovery. However, the optimal anesthetic approach—general, regional, or local—remains a subject of ongoing debate. This comprehensive review synthesizes evidence from comparative studies to evaluate how anesthetic modality affects key perioperative outcomes, including cardiopulmonary complications, mortality, ICU admission, and hospital length of stay. Findings indicate that regional and local anesthesia may reduce physiological stress and enhance postoperative recovery in appropriately selected patients. Nevertheless, general anesthesia remains essential in scenarios requiring advanced airway protection or complex intraoperative monitoring. Rather than promoting a single preferred technique, current evidence supports an individualized, patient-centered anesthetic strategy. High-quality prospective trials are needed to further refine best practices and guide anesthetic decision-making in EVAR.