Totally Percutaneous Endovascular Aneurysm Repair Using the Preclosing Technique: Towards the Least Invasive Therapeutic Alternative

Surg Laparosc Endosc Percutan Tech. 2015 Aug;25(4):354-7. doi: 10.1097/SLE.0000000000000176.

Abstract

Endovascular aneurysm repair (EVAR) offers a minimally invasive approach for the treatment of abdominal aortic aneurysms, whereas arterial closure devices have made totally percutaneous EVAR feasible. This is a retrospective analysis of patients undergoing EVAR in a single institution, between May 2011 and October 2014 using surgical or percutaneous access. Hemostasis after percutaneous access was achieved with 2 Perclose ProGlide suture-mediated devices and a preclosing technique. Technical success, local complications, procedural times, length of hospitalization, and need for analgesics are recorded and compared between groups. Among 82 patients/164 groins, 120/164 (73%) groins underwent percutaneous and 44/146 (27%) surgical access. An average 2.2 devices per access site was used. Technical success was 95% (114/120). Local complications (3.3% vs. 11.4%, P=0.05), procedural times (90 vs. 112 min, P=0.05), hospitalization (2 vs. 5 d, P<0.001), and postoperative analgesics (0.7 vs. 4.4 g IV paracetamol, P=0.01) were significantly reduced after percutaneous access which overall seems safe and effective to perform EVAR.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / surgery*
  • Blood Vessel Prosthesis Implantation / methods*
  • Endovascular Procedures / methods*
  • Female
  • Femoral Artery
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Suture Techniques / instrumentation*
  • Sutures*
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome