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Risk Factors for Access-Related Adverse Events Related to the Preclose Technique in Thoracic Endovascular Aortic
Yi-Yun Xie1, Yong-Lin Qin1, Jia-Jie Ji1
1Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, People's Republic of China.
Insights
The sheath-to-femoral artery ratio (SFAR) is a key predictor of complications during thoracic endovascular aortic repair (TEVAR) using the preclose technique. An SFAR below 0.85 significantly increases the risk of access-related adverse events.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure for aortic diseases.
- The preclose technique facilitates vascular access but carries risks of access-related adverse events (AEs).
- Identifying risk factors for AEs is crucial for improving patient outcomes in TEVAR.
Purpose of the Study:
- To identify risk factors for access-related AEs associated with the preclose technique in TEVAR.
- To evaluate the sheath-to-femoral artery ratio (SFAR) as a predictor of these AEs.
Main Methods:
- A retrospective analysis of 91 patients undergoing TEVAR with the preclose technique.
- Patients were categorized into groups with and without access-related AEs.
- Risk factors including patient demographics, anatomical characteristics, and sheath size were analyzed, with a focus on SFAR.
Main Results:
- The sheath-to-femoral artery ratio (SFAR) was identified as an independent risk factor for access-related AEs (OR, 251.748; P = .002).
- A cutoff SFAR of 0.85 was associated with a significantly higher incidence of AEs (33.3% vs 5.2%, P = .001).
- Lower SFAR values correlated with increased rates of arterial stenosis (21.2% vs 0.0%, P = .001).
Conclusions:
- SFAR is a significant independent predictor of access-related AEs in TEVAR using the preclose technique.
- An SFAR cutoff of 0.85 can help identify high-risk patients.
- SFAR may serve as a valuable preoperative criterion for optimizing access site selection and mitigating potential complications.
Purpose:
To analyze the risk factors for access-related adverse events (AEs) of the preclose technique in thoracic endovascular aortic repair (TEVAR).
Materials And Methods:
Ninety-one patients with Stanford type B aortic dissection who underwent the preclose technique in TEVAR between January 2013 and December 2021 were included. According to the occurrence of access-related AEs, the patients were divided into 2 groups: those with AE and those without AE. Age, sex, combined diseases, body mass index, skin depth, femoral artery diameter, access calcification, iliofemoral artery tortuosity, and sheath size were recorded for risk factor analysis. The sheath-to-femoral artery ratio (SFAR), the ratio of the femoral artery inner diameter (in millimeters) to the sheath's outer diameter (in millimeters), was also included in the analysis.
Results:
SFAR was identified as an independent risk factor for AEs using multivariable logistic analysis (odds ratio, 251.748; 95% CI, 7.004-9,048.534; P = .002). The cutoff value of SFAR was 0.85 and was related to a higher incidence of access-related AEs (5.2% vs 33.3%, P = .001), especially to a higher stenosis rate (0.0% vs 21.2%, P = .001).
Conclusions:
SFAR is an independent risk factor for access-related AEs of preclose in TEVAR with a cutoff value of 0.85. SFAR could be a new criterion for preoperative access evaluation in high-risk patients that may allow the detection and treatment of access-related AEs at the early stage.
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