Percutaneous AAA repair: is it safe?

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Endovascular repair (EVR) is a standard treatment for abdominal aortic aneurysms (AAA).
• Traditional EVR often requires open femoral artery exposure (cutdown) for large-bore sheath insertion.
• Minimally invasive techniques are sought to improve patient outcomes and reduce complications.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous transfemoral EVR for AAA using large-bore sheaths (14-F to 20-F).
• To compare outcomes of percutaneous EVR with traditional femoral cutdown approaches.

Main Methods:

• A prospective, nonrandomized study included 95 patients undergoing EVR with percutaneous large-bore sheath insertion.
• Vascular closure was achieved using sutures and a closure device after sheath removal.
• Outcomes including blood loss, operative time, and length of stay were compared to 26 patients who had EVR via femoral cutdown.

Main Results:

• Percutaneous closure was successful in 82% of patients; 18% required intraoperative or early postoperative repair.
• The failure rate varied by sheath size, with higher rates for larger sheaths (20-F).
• No significant differences were observed in operative time, blood loss, or length of stay between percutaneous and cutdown groups, though blood loss was higher in failed percutaneous cases.

Conclusions:

• Percutaneous transfemoral EVR for AAA using large-bore sheaths is a safe procedure.
• This technique successfully enables a majority of patients to avoid femoral cutdown.
• Late complications associated with percutaneous EVR are infrequent.