Totally percutaneous aortic aneurysm repair: experience and prudence

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Treatment

Background:

• Totally percutaneous aortic aneurysm repair offers technical feasibility and low morbidity.
• Percutaneous arterial closure complications, though infrequent, can be severe.

Purpose of the Study:

• Evaluate institutional experience with percutaneous closure of large-bore access sites.
• Compare outcomes with existing literature.
• Identify factors predicting conversion to open repair and complications.

Main Methods:

• Retrospective review of prospectively collected data (Dec 2002-Aug 2005).
• Analysis of patients undergoing percutaneous closure of >12F access sites using a suture-mediated device (Prostar XL).
• Assessment of technical success, conversion rates, complications, and vessel diameters via CT angiography.

Main Results:

• Successful closure in 93.7% of 79 access sites across 49 patients.
• Six percent of closures failed, requiring open repair.
• Complications (4.1%) included retroperitoneal hematoma and iliac artery injury (one fatal).
• Morbid obesity and sheath size >20F significantly increased complication rates (P=.02 and P=.01).
• No thrombotic or infectious complications; one small pseudoaneurysm detected.

Conclusions:

• Totally percutaneous aortic aneurysm repair is technically feasible without impacting femoral artery luminal diameter.
• Complication rates are higher in morbidly obese patients and with sheaths >20F.
• Careful patient selection and meticulous technique are crucial for minimizing complications.