Totally percutaneous aortic aneurysm repair: methods and outcomes using the fully integrated IntuiTrak endovascular...

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) offers a minimally invasive option for treating abdominal aortic aneurysms (AAAs).
• Increasing sheath size in PEVAR is associated with higher risks, necessitating innovative delivery systems for challenging anatomies.

Purpose of the Study:

• To evaluate the feasibility and outcomes of PEVAR using a novel delivery system with an integrated 19Fr introducer sheath.
• To assess the safety and efficacy of this system in patients with challenging access vessel anatomy, including calcified and tortuous vessels.

Main Methods:

• A prospective, controlled evaluation of 57 consecutive patients undergoing PEVAR between December 2008 and April 2010.
• Procedures utilized a new delivery system with a 19Fr introducer sheath and the Prostar XL device for vessel closure under conscious sedation and local anesthesia.

Main Results:

• The study included patients with a mean age of 74 years and a median AAA diameter of 5.4 cm; 98% had calcified/tortuous access vessels.
• Technical success was 98%, with minimal blood loss (79 mL). Major access-related complications occurred in 5 patients (8.8%) within 30 days.
• One conversion to open repair was necessary due to very small access vessels (4 mm).

Conclusions:

• PEVAR using the IntuiTrak System with a 19Fr introducer sheath and Prostar XL closure is feasible, even in patients with challenging access anatomy.
• This approach demonstrates acceptable safety and efficacy for AAA repair.
• Further investigation in a prospective, multicenter, randomized trial is recommended to validate these findings.