Total percutaneous endovascular repair of abdominal aortic aneurysms using Perclose ProGlide closure devices.
OBJECTIVE
To describe a technique for access site closure in percutaneous abdominal aortic aneurysm (AAA) repair using double Perclose ProGlide devices to overcome the problems associated with the bulky delivery system and braided suture of the antecedent (Prostar) device.


METHODS
After obtaining guidewire access, 2 Perclose ProGlide sutures are deployed at 90 degrees to each other. The appropriate sheaths are placed over the stiff guidewires. After the stent-graft procedure is completed, an assistant holds pressure while the knots are tightened with the stiff guidewire still in the artery. Once the second knot is tightened with the knot pusher and after confirming adequate hemostasis, the wire is removed, pressure is applied, and heparin reversed. This method has been used in 17 consecutive patients (age range 65-85 years) undergoing endovascular AAA repair. One patient needed patch angioplasty and 2 required small incisions for additional suture placements (81% primary success rate for total percutaneous repair, 90% success rate for all sites).


CONCLUSIONS
We have found the double Perclose ProGlide technique to be easy to use, safe, and feasible for total percutaneous AAA repair. More experience with longer follow-up is needed to assess its potential to replace the Perclose Prostar closure device for total percutaneous AAA repairs.
Dosluoglu
Hasan H
HH
Division of Vascular Surgery, VA Western NY Healthcare System, State University of New York at Buffalo, New York 14215, USA. dosluoglu@yahoo.com
Cherr
Gregory S
GS
Harris
Linda M
LM
Dryjski
Maciej L
ML
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000293:injuries* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005240:Feasibility Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D011677:Punctures / Q000009:adverse effects*; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome