[Treatment of aortic aneurysm with a complete percutaneous technique]

The treatment of aortic aneurysms is achievable also without laparotomy. With a special technique it is now possible to perform the endovascular aneurysm repair totally percutaneous using an endovascular suture device. With the purpose to reduce the invasiveness of the treatment of abdominal aneurysms, the new technique was used also during procedures requiring large bore devices up to 14-27F. The aim of this retrospective study was to report on results after performing the new technique in 80 patients and on the benefits and limits of its use.

From 1.10.1999 to 31.12.2001, 102 patients with aneurysm disease were treated by endovascular techniques. In 80 cases (68 men, 12 women; mean age 71.3 years) a completely percutaneous procedure was planned. The diameter of the introducer sheaths was 18-27F for the main body of the stent-graft and 14-18F for the contralateral limb. Most patients were operated under spinal anesthesia. Postoperative control included complete physical examination and duplex ultrasound scans.

In 5 of 80 cases the implantation of the endograft could not be performed percutaneously. In 5 of 145 femoral arteries (3.4 %) effective hemostasis could not be achieved. Complications requiring surgery (two pseudoaneurysms, two arterial occlusions) occurred in 4 cases (2.8 %). By duplex ultrasound normal findings were detected in the remaining 136 cases (93,8 %). In 68 of 80 treated patients (85 %) complete percutaneous technique was successful.

Using the preclose-technique it was possible to suture the artery even after using large bore introducer sheaths without cut down. Patient selection, exact puncture technique and accurate use of the device are important factors for success. The technological improvement of the arterial closure devices will allow a more frequent use of the percutaneous technique for aneurysm repair in the future.