Analysis of Determinants for Suture-mediated Closure Device Failure During EVAR Procedures
W Garabet1, A Arnautovic1, L Meurer1
1Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany.
Vascular and Endovascular Surgery
|July 14, 2023
Summary
Suture-mediated closure device (SMCD) failure during endovascular aortic repair (EVAR) is linked to common femoral artery calcification and prior dual anti-platelet therapy (DAPT). Platelet testing before EVAR may improve patient safety.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Endovascular aortic repair (EVAR) is a primary treatment for infrarenal aortic pathologies.
- Suture-mediated closure devices (SMCDs) are commonly used for hemostasis after EVAR.
- Understanding SMCD failure is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify factors contributing to SMCD failure in elective and emergency EVAR procedures.
- To analyze the association of patient comorbidities, vessel morphology, and blood parameters with SMCD failure.
Main Methods:
- Retrospective analysis of archived medical records from EVAR patients at University Hospital Düsseldorf.
- Evaluation of patient comorbidities, access vessel characteristics, and hemostasis-related blood parameters.
- Application of univariate and multivariable binary logistic regression for statistical analysis.
Main Results:
- The overall SMCD failure rate was 4.3% across 71 patients (139 femoral accesses).
- Common femoral artery (CFA) calcification, aortic bifurcation diameter, and pre-procedural dual anti-platelet therapy (DAPT) were associated with SMCD failure.
- Anterior plaque formation in the CFA (OR 44.9) and DAPT (OR 30.5) were significant predictors of SMCD failure.
Conclusions:
- CFA calcification status is confirmed as a significant factor in SMCD failure.
- DAPT, even when discontinued before EVAR, showed an association with SMCD failure.
- Pre-EVAR platelet testing may be beneficial for enhancing patient safety and procedural success.
