title: Percutaneous access for endovascular aneurysm repair: a systematic review.
abstract: BACKGROUND
  Recent developments in aortic stent-graft technology have led to an increase in the use of wholly percutaneous endovascular aneurysm repair (P-EVAR). The literature was systematically reviewed to analyse the results of P-EVAR.
  
  
  METHODS
  A systematic review of P-EVAR was performed using Ovid-MEDLINE in-process and other nonindexed citations and Ovid-MEDLINE and EMBASE (January 1991-July 2009). Primary outcomes reviewed were success rate and loco-regional complications. Secondary outcomes included; operative time, hospital stay, time to ambulation, blood loss and cost. Prospective randomised and controlled nonrandomised studies were included as were case series (retrospective and prospective). Case reports, letters, review articles and non-English language articles were excluded.
  
  
  RESULTS
  Twenty-two papers were identified. These included randomised trials (n=1); prospective nonrandomised (n=10) and retrospective studies (n=11). P-EVAR was attempted in 1087 patients (1751 groins). Overall success rate of percutaneous arterial closure was 92% (90.1-93.9, 95% CI). Access related complication rate was 4.4% (3.5-5.3, 95% CI). Seven studies provided data on access related complications in open access cohorts (O-EVAR). In these studies, P-EVAR was associated with fewer access related complications (RR 0.47, 95% CI 0.28-0.78, p=0.004). P-EVAR was associated with reduced operative time.
  
  
  CONCLUSIONS
  P-EVAR appears safe and effective in selected patients. Local access related complications were low. Further work is required to identify the most suitable candidates for P-EVAR.
authors.affiliation: St. George's Vascular Institute, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Malkawi
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome