title: Unselected percutaneous access with large vessel closure for endovascular aortic surgery: experience and predictors of technical success.
abstract: BACKGROUND
  The effectiveness of percutaneous access with large vessel closure (pEVR) in non-selective groups of patients undergoing endovascular aneurysm repair (EVR) remains unclear. This study aims to identify factors that predict success in pEVR, performed using percutaneous access and the Prostar XL (Abbott Vascular, Redwood City, Calif) closure device.
  
  
  METHODS
  Consecutive patients who underwent pEVR between April 2010 and March 2011 were identified from a prospectively maintained database. Procedural and postoperative outcomes were compared with consecutive patients who underwent endovascular aneurysm repair using standard open femoral access between April 2008 and March 2009. To determine the predictors of technical success of pEVR, the association between clinical, anatomical and procedural variables with technical success, were examined in a multiple logistic regression model.
  
  
  RESULTS
  pEVR was attempted in 186 common femoral arteries (CFAs) with a technical success rate of 95.2% (177/186). Conventional open femoral access in the historic control group was performed in 208 CFAs. pEVR was associated with a reduced operation length (131 min [105-152] versus 150 min [124-195], p≤0.001) and length of stay (2 days [2-5] versus 4 days [2-7], p = 0.01) in patients undergoing infrarenal EVR. In secondary analysis of outcomes following percutaneous access in 91 CFAs, pre-operative renal failure, CFA depth (min and max), CFA diameter (min and max) and operator experience predicted success of percutaneous access in univariate analysis. Operator experience was the only independent predictor of technical success (p = 0.05) after adjustment for all confounding variables.
  
  
  CONCLUSIONS
  pEVR using the Prostar XL device is effective in the majority of patients. In this study there were benefits in terms of reduced postoperative complications, shorter procedures and decreased lengths of stay. Operator experience is a predictor of technical success for pEVR, irrespective of clinical and morphological characteristics at baseline.
authors.affiliation: St George's Vascular Institute, 4th Floor, St James Wing, St George's Healthcare NHS Trust, London SW17 0QT, UK. mmetcalfe@doctors.org.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Metcalfe
authors.forename: J R W
authors.initials: JR
authors.lastname: Brownrigg
authors.forename: S A
authors.initials: SA
authors.lastname: Black
authors.forename: T
authors.initials: T
authors.lastname: Loosemore
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies