Comparison of Early Efficacy of the Percutaneous Presuture Technique with the Femoral Artery Incision Technique in Endovascular Aortic Repair under Local Anesthesia for Uncomplicated Type B Aortic Dissection

Qingsong Wu; Debin Jiang; Xiaochai Lv; Jiaxin Zhang; Rongda Huang; Zhihuang Qiu; Liangwan Chen

doi:10.1155/2022/6550759

Comparison of Early Efficacy of the Percutaneous Presuture Technique with the Femoral Artery Incision Technique in Endovascular Aortic Repair under Local Anesthesia for Uncomplicated Type B Aortic Dissection

J Interv Cardiol. 2022 Aug 22:2022:6550759. doi: 10.1155/2022/6550759. eCollection 2022.

Authors

Qingsong Wu^{1

2

3

4}, Debin Jiang^{1

2

3

4}, Xiaochai Lv^{1

2}, Jiaxin Zhang^{1

2}, Rongda Huang^{1

2}, Zhihuang Qiu^{1

2

3

4}, Liangwan Chen^{1

2

3

4

5}

Affiliations

¹ Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
² Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian 350001, China.
³ Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian 350001, China.
⁴ Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fuzhou, Fujian 350001, China.
⁵ Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fuzhou, Fujian 350001, China.

Abstract

Objective: To compare the efficacy of the percutaneous presuture technique (PPST) and the femoral artery incision technique (FAIT) under local anesthesia in the treatment of endovascular aortic repair (EVAR) for patients with uncomplicated type B aortic dissection (uTBAD).

Method: Two hundred and ninety-five patients diagnosed with uTBAD who underwent EVAR under local anesthesia from June 2017 to December 2021 were consecutively and randomly selected for retrospective analysis. The PPST was performed in 178 cases and the FAIT was performed in 117 cases. The clinical characteristics and surgical and postoperative data from the two groups were analyzed.

Results: There were no significant differences in clinical characteristics between the two groups (p > 0.05). The operative time of the PPST group was significantly shorter than that of the FAIT group (46 (33, 58) versus 72 (67.5, 78.0) minutes, p < 0.001), as was the operative approach procedure time (6 (4.5, 9.0) versus 38 (36.5, 43.5) minutes, p < 0.001), and length of postoperative hospital stay (5.19 ± 2.26 versus 8.33 ± 3.76 days, p < 0.001). There were fewer postoperative approach-related procedural complications in the PPST group than in the FAIT group (2 versus 12, p < 0.001); similarly, the average frequency of postoperative wound disinfection was significantly lower in the PPST group (1.08 ± 0.39 versus 3.31 ± 0.91 times, p < 0.05). Obesity was identified as an independent risk factor for postoperative approach-related procedural complications (OR, 22.26; 95% CI, 4.74-104.49; p < 0.001).

Conclusions: The PPST has comparable safety and efficacy to the FAIT in EVAR under local anesthesia. It can shorten the length of hospital stay, reduce operation time, lower the risk of wound-related complications, reduce the frequency of postoperative wound disinfection, and hasten postoperative recovery. It can therefore be used as a first-line surgical technique in EVAR of uTBAD under local anesthesia, especially in obese patients.

MeSH terms

Anesthesia, Local
Aortic Aneurysm, Abdominal* / complications
Aortic Aneurysm, Abdominal* / surgery
Aortic Dissection* / complications
Aortic Dissection* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / methods
Femoral Artery / surgery
Humans
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Surgical Wound* / surgery
Treatment Outcome