Percutaneous AAA repair: is it safe?
OBJECTIVE
To assess if percutaneous insertion of large-bore sheaths is safe during endovascular repair (EVR) for abdominal aortic aneurysms (AAA).


METHODS
Ninety-five AAA patients undergoing EVR had the endografts implanted percutaneously via 14-F to 20-F sheaths in a prospective nonrandomized study. Vascular sutures were applied bilaterally to the common femoral arteries using a vascular closure device; the sutures were tied after sheath withdrawal. Blood loss, operative time, and length of stay (LOS) were compared to 26 AAA patients undergoing EVR with bilateral femoral cutdowns before the percutaneous technique was available. Follow-up included duplex ultrasonography and clinical examination.


RESULTS
Bilateral percutaneous closure of the femoral arteries was successful in 78 (82%) patients. Fifteen patients required arteriorrhaphy intraoperatively and 2 others within 24 hours. The failure rate was 20%, 0%, 3%, and 7% for the 20-F, 18-F, 16-F, and 14-F introducers, respectively. Blood loss was 400 mL (range 0-1800) in successful cases, 900 mL (range 0-3000) in failures (p<0.0001). One deep infection at the puncture site required thrombectomy and patchplasty; no other late complication occurred. There was no significant difference in operative time, blood loss, and LOS between patients treated with percutaneous EVR and those with primary femoral exposure.


CONCLUSIONS
Percutaneous transfemoral EVR of AAA using large-bore introducer sheaths is safe. More than three quarters of the patients avoid femoral cutdown. Late complications are rare.
Börner
Gabriel
G
Department of Vascular Surgery, Lund University, Malmö, Sweden. Gabriel.Borner@semera.se
Ivancev
Krasnodar
K
Sonesson
Björn
B
Lindblad
Bengt
B
Griffin
Dennis
D
Malina
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology