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Related Experiment Video

Updated: May 16, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Access techniques for EVAR: percutaneous techniques and working with small arteries.

David J Minion1, Daniel L Davenport

  • 1Department of Surgery, University of Kentucky Medical School, Lexington, KY 40536, USA. djmini@email.uky.edu

Seminars in Vascular Surgery
|December 5, 2012
PubMed
Summary

Percutaneous femoral access for endovascular aneurysm repair (EVAR) reduces operative time but increases serious morbidity compared to open cutdown. Iliac artery access may be preferred for specific anatomical challenges.

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Endovascular aneurysm repair (EVAR) relies heavily on vascular access.
  • Traditionally, open surgical cutdown of the femoral artery is used.
  • Percutaneous techniques offer an alternative for large-bore sheath placement.

Purpose of the Study:

  • To compare outcomes of open femoral artery exposure versus percutaneous femoral access in elective EVAR.
  • To evaluate the safety and efficacy of different access strategies for EVAR.

Main Methods:

  • Retrospective analysis of elective EVAR cases from the American College of Surgeons National Surgical Quality Improvement Program database.
  • Comparison of open cutdown (n=2,802) versus percutaneous femoral access (n=1,781).
  • Analysis of operative time, 30-day serious morbidity, mortality, and length of stay.

Main Results:

  • Percutaneous access significantly decreased operative time (150 ± 68 min) compared to open cutdown (159 ± 63 min).
  • Serious 30-day morbidity was higher with percutaneous access (7.2%) versus open cutdown (5.8%).
  • No significant differences in 30-day mortality or length of stay were observed between groups.

Conclusions:

  • Percutaneous femoral access offers reduced operative time for EVAR but is associated with increased serious morbidity.
  • Iliac artery exposure may be more appropriate for patients with inadequate iliac vessels.
  • Careful patient selection and management of complications are crucial for all EVAR access methods.