Percutaneous endovascular abdominal aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Surgical Outcomes

Background:

• Endovascular Abdominal Aortic Aneurysm (AAA) repair necessitates femoral artery access.
• Traditional open femoral arteriotomy carries specific complication risks.
• Percutaneous closure techniques offer a less invasive alternative.

Purpose of the Study:

• To compare the outcomes of percutaneous femoral artery closure versus open femoral arteriotomy following endovascular AAA repair.
• To evaluate the success rates and complication profiles of different closure methods.
• To identify factors influencing the success of percutaneous closure.

Main Methods:

• Prospective, nonrandomized study of 95 patients undergoing endovascular AAA repair.
• Comparison of bilateral open femoral arteriotomies, bilateral percutaneous closures, and mixed approaches.
• Use of 8 Fr/10 Fr Perclose devices in an "off-label preclose technique" with 16 Fr and 22 Fr sheaths.

Main Results:

• Successful percutaneous closure rates were 85% for 16 Fr sheaths and 64% for 22 Fr sheaths (p < 0.027).
• Overall bilateral percutaneous closure success was 63%.
• Wound complication rates were low and not significantly different between percutaneous (0.9%) and open (3.6%) methods.

Conclusions:

• Procedural success for percutaneous closure in endovascular AAA repair is significantly influenced by sheath size.
• Femoral artery closure using devices with 16 Fr or smaller sheaths achieves success rates of at least 85%.
• Percutaneous closure is a safe and effective alternative to open arteriotomy, with comparable wound complication rates.