Endovascular bailout for closure-device failure following percutaneous endovascular aneurysm repair: A selective...

Suture-mediated closure devices have enabled totally percutaneous endovascular aneurysm repair (EVAR). Although hemorrhagic access-site complications are well recognized, closure-device related common femoral artery (CFA) stenosis or dissection is less well described. We report the use of an endovascular bailout strategy for these complications and assess midterm outcomes.

Between 2018 and 2023, a total of 751 consecutive percutaneous EVAR procedures were performed at a single tertiary center. Closure-device malfunction occurred in 66 cases (8.7%). Ten patients, representing 12 limbs (approximately 1.3% of all procedures), developed focal, flow-limiting CFA stenosis or dissection with controllable bleeding and were treated using an endovascular approach. Data were analyzed retrospectively from an institutional registry. Device selection was based on lesion characteristics.

Technical success was achieved in all cases. Bare stents were used for focal dissection or intimal flap without bleeding, whereas covered stents were used in the presence of arterial injury or contrast extravasation. At a median follow-up of 2.5 years (interquartile range, 1.6-3.5 years), imaging, mainly computed tomography angiography, showed 100% primary patency. No clinically significant restenosis or occlusion was observed. Most other closure-device failures in the cohort were managed with adjunctive hemostasis or open repair, indicating that this group represents a specific subset of complications.

Closure-device related CFA stenosis or dissection is an uncommon but distinct complication after percutaneous EVAR. When the lesion is focal, endovascular bailout can restore flow effectively and avoid surgical exploration. This approach fits within routine EVAR practice and provides durable results at midterm follow-up.