Clinical ResearchPercutaneous Access for Endovascular Abdominal Aortic Aneurysm Repair: Can Selection Criteria Be Expanded?
Introduction
Endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) has been accepted worldwide for patients with suitable aneurysm morphology. Due to the need for introduction of large sheaths, open common femoral artery (CFA) exposure has become the gold standard for EVAR access. However, improvements in arteriotomy closure devices have made percutaneous access possible, with secure closure even after the use of large sheaths. The first report of percutaneous EVAR with the “preclose” technique appeared in 1999.1 Although subsequent limited experience has been favorable, percutaneous EVAR has not been considered universally applicable. Due to potential problems with secure arteriotomy closure, the anatomic considerations of femoral artery calcification and morbid obesity have generally been considered relative contraindications to percutaneous EVAR.2, 3 However, these criteria have not been systematically evaluated. As we have gained experience with percutaneous EVAR (P-EVAR) in selected patients, we hypothesized that the technique could be applied to most patients regardless of femoral artery calcification or body mass index (BMI). The purpose of this study was to evaluate whether P-EVAR can be safely performed in patients with suboptimal femoral anatomy, with particular emphasis on anatomic changes in the CFAs using automated three-dimensional (3-D) reconstruction measurements.
Section snippets
Methods
We reviewed our experience with 173 consecutive patients who underwent EVAR at our institution from March 2005 to April 2007. During this period, 35 patients (20%) underwent P-EVAR. Twenty-two of these (63%) had complete pre- and postoperative computed tomographic (CT) imaging for analysis of the femoral arteries, and these subjects served as the focus of our study. Patients with inadequate imaging of the femoral arteries were excluded. Excluded studies mainly included poorly contrasted scans,
Results
P-EVAR and O-EVAR patients had similar demographics and comorbidities, as seen in Table I. Obesity (BMI >30 kg/m2) was relatively common in this study, occurring in six (27%) of the percutaneous and six (27%) of the open access patients (p = 0.78). There was no difference in the type of EVAR device (p = 0.19) (Table I), and the median sheath size was 18F in CFAs accessed in both groups (p = 0.98). The mean number of components placed through each CFA was 1.6 ± 0.7 in the percutaneous group and 1.4 ± 0.5
Discussion
A completely percutaneous approach for EVAR is appealing. It is consistent with the minimally invasive nature of EVAR, patients like it, and it has the benefit of fewer local wound complications. The devices are used off-label for P-EVAR, and there are no large, randomized studies comparing it to O-EVAR. However, there have been increasing reports of successful use of the preclose technique.5, 6, 7, 8 There is a learning curve as with any other technique, and patient selection may play an
Conclusion
This study demonstrates that patients with obesity or severely calcified femoral arteries can be successfully treated percutaneously with fewer minor groin complications. Anatomic analysis demonstrated no deformation of the CFAs after P-EVAR.
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2018, Journal of Vascular SurgeryCommon Femoral Artery Caliber Changes after Percutaneous versus Surgical Access in Endovascular Aneurysm Repair in the Asian Population
2018, Annals of Vascular SurgeryCitation Excerpt :Our study performed in an Asian population is concordant with previous studies performed in the Western population. There are no significant differences in caliber changes when comparing PEVAR and SEVAR6 and that EVAR does not cause any significant caliber changes from baseline whether a percutaneous5,7 or surgical approach is used. For instance, early in the experience of PEVAR, Starnes et al.7 first reported that PEVAR did not have any effect on luminal diameter and Lin et al.5 reported similar findings in a cohort with 12 months follow-up.
Femoral Arterial Haemostasis Using an Anchored Collagen Plug after Percutaneous EVAR with an Ultra-Low Profile Device: Prospective Audit of an Evolving “Post-Close” Technique
2017, European Journal of Vascular and Endovascular SurgeryEditor's Choice – Arteriotomy Closure Devices in EVAR, TEVAR, and TAVR: A Systematic Review and Meta-analysis of Randomised Clinical Trials and Cohort Studies
2017, European Journal of Vascular and Endovascular SurgeryCitation Excerpt :In the SCD group only one study used the fascia closure technique.18 Most procedures were performed in the operating theatre (62.5%, 10 studies).1–3,8,17,19,20,24–26 One TAVR study performed its implantations in the catheterisation room,23 and six studies did not mention the location of the intervention.4,5,18,21,22,27