Complication rate of the fascia closure technique in endovascular aneurysm repair

To assess the rate of complications associated with the fascia closure technique for femoral access sites in which 18-F or 20-F sheaths were introduced during endovascular aneurysm repair (EVAR).

A retrospective analysis was done of 50 consecutive patients (41 men; median age 75 years, range 62-85) who received Excluder stent-grafts in planned percutaneous EVAR procedures from May 2006 until December 2009. The fascia closure technique was routinely used for all femoral access sites in which large bore (18-F and 20-F) introducers were employed. One patient with extremely calcified and narrowed vessels was converted to primary cutdown bilaterally after percutaneous access failed. In the 49 remaining patients, 81 femoral access sites were closed with the fascia closure technique; 17 sites with smaller 12-F introducers were closed using other techniques. Computed tomographic angiography (CTA) was performed within 30 days, at 6 months, and at 1, 2, and 3 years.

Of the 81 femoral access sites closed with the fascia closure technique, only 1 patient had persistent bleeding that required an immediate cutdown and suture repair of the deep femoral artery (99.0% technical success rate). In the immediate postoperative period, 5 patients required additional interventions for bleeding (n = 2), occlusion (n = 2), or a pseudoaneurysm [92.6% 30-day technical success]. At 30 days, 11 (13.9%) of 79 access sites had pseudoaneurysms, all of which resolved within a year; none required a secondary intervention. Later surveillance scans did not detect pseudoaneurysms.

The fascia closure technique during EVAR is safe and has few complications. The low frequencies of pseudoaneurysms and other access site complications make the femoral closure technique a durable alternative.