Optimizing Femoral Access in Emergency EVAR with a Decision-Making Algorithm

Area of Science:

• Vascular Surgery
• Interventional Cardiology

Background:

• Endovascular aneurysm repair (EVAR) is preferred for abdominal aortic aneurysms (AAAs) due to its minimally invasive nature.
• Common femoral artery (CFA) access is key for EVAR, with both percutaneous and surgical methods available.
• Emergent EVAR can present challenges with percutaneous access, potentially leading to complications and surgical conversion.

Purpose of the Study:

• To evaluate the effectiveness of a decision-making algorithm in reducing surgical conversions during emergent EVAR.
• To analyze the impact of the algorithm on perioperative outcomes, including mortality, morbidity, and procedure time.

Main Methods:

• Retrospective analysis of 74 patients undergoing emergent EVAR.
• Implementation and assessment of a specific decision-making algorithm for CFA access.
• Comparison of outcomes before and after algorithm implementation, focusing on surgical conversion rates and procedure times.

Main Results:

• The decision-making algorithm led to a reduction in surgical conversions and operating time.
• Percutaneous CFA access was more challenging in patients with severe atherosclerosis or smaller vessel diameters.
• Perioperative mortality, morbidity, and surgical exposure time were also evaluated.

Conclusions:

• A structured decision-making algorithm can optimize outcomes in emergent EVAR by minimizing percutaneous access failures and surgical conversions.
• Patient-specific anatomical factors of the CFA significantly influence the success of percutaneous access.
• Further research is warranted to refine femoral artery access strategies for EVAR and reduce associated complications.