Fascia suturing of large access sites after endovascular treatment of aortic aneurysms and dissections.
OBJECTIVE
To evaluate a technique for closure of a femoral artery access in which the cribriform fascia covering the common femoral artery is sutured.


METHODS
A consecutive series of 127 patients (103 men; median age 74 years, range 45- 89) underwent endovascular aortic aneurysm repair between August 2001 and September 2004. Twelve patients underwent a secondary intervention for a total of 139 procedures in the group. Sixty-one (43.9%) of the 139 operations were acute. Among the 257 femoral arteries used for access, a fascia suturing technique was performed in 131 (51.0%). Data were collected for analysis of access site complications, bleeding, thrombosis, pseudoaneurysm, and stenosis. A subgroup of 72 patients had ankle-brachial indexes (ABI) recorded; another subgroup of 50 patients were also investigated by duplex ultrasonography.


RESULTS
Complications occurred in 18 (13.7%) of the 131 sutured cases. The majority (n = 16) arose within 24 hours: 8 cases of perioperative bleeding or thrombosis required open surgery and 8 cases were reoperated within 24 hours for bleeding (n = 4), thrombosis (n = 3), and 1 intimal dissection. The acute failure rate was 12.2%. Two patients had late complications: 1 case of neuralgia and 1 pseudoaneurysm that required acute surgery 28 months postoperatively. The ABI did not change significantly from pre- to postoperatively in the 72 patients examined. Five patients with stenoses did not have a reduction in ABI. In the 66 sites examined with ultrasound in 50 patients, 3 minor pseudoaneurysms were detected.


CONCLUSIONS
The fascia suturing technique for closure of a femoral artery access during endovascular repair of aortic diseases is feasible, even in acute situations. Failures can be managed easily. Late complications requiring additional procedures are rare.
Larzon
Thomas
T
Department of Surgery, Orebro University Hospital, Orebro, Sweden. thomas.larzon@orebroll.se
Geijer
Håkan
H
Gruber
Göran
G
Popek
Robert
R
Norgren
Lars
L
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000628:therapy*; D001014:Aortic Aneurysm / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D000071938:Fasciotomy; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D011677:Punctures; D015607:Stents; D013536:Suture Techniques; D016896:Treatment Outcome; D014463:Ultrasonography