Percutaneous versus Cutdown Access for Endovascular Aortic Repair

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Surgical Access Techniques

Background:

• Thoracic and abdominal aortic aneurysms require endovascular repair.
• Femoral artery access is crucial for endovascular aortic repair.
• Comparing percutaneous versus open surgical cutdown access is important for optimizing patient outcomes.

Purpose of the Study:

• To compare the outcomes of percutaneous femoral access versus open surgical cutdown for thoracic/abdominal endovascular aortic repair.
• To evaluate operative duration, complication rates, and mortality between the two access methods.

Main Methods:

• Retrospective review of 59 patients undergoing endovascular aortic repair (2015-2022).
• Patients categorized into percutaneous or cutdown femoral access groups.
• Comparison of demographic data, risk factors, operative duration, complication/mortality rates, and hospital/ICU stay.

Main Results:

• The percutaneous group (59%) had a significantly shorter operative duration (141 vs. 218 min) and hospital stay (11.6 vs. 21.5 days).
• Lower ICU admission rates were observed in the percutaneous group (40% vs. 66.7%).
• A sheath to common femoral artery diameter ratio ≥0.74 was linked to increased complication (OR 12.0) and mortality (OR 5.79) risks.

Conclusions:

• Percutaneous femoral access is a time-efficient and viable alternative to surgical cutdown for endovascular aortic repair.
• Shorter operative times and hospital stays are associated with the percutaneous approach.
• The sheath to common femoral artery diameter ratio may aid in preoperative risk assessment for complications and mortality.