title: Totally Percutaneous Endovascular Aneurysm Repair Using the Preclosing Technique: Towards the Least Invasive Therapeutic Alternative.
abstract: Endovascular aneurysm repair (EVAR) offers a minimally invasive approach for the treatment of abdominal aortic aneurysms, whereas arterial closure devices have made totally percutaneous EVAR feasible. This is a retrospective analysis of patients undergoing EVAR in a single institution, between May 2011 and October 2014 using surgical or percutaneous access. Hemostasis after percutaneous access was achieved with 2 Perclose ProGlide suture-mediated devices and a preclosing technique. Technical success, local complications, procedural times, length of hospitalization, and need for analgesics are recorded and compared between groups. Among 82 patients/164 groins, 120/164 (73%) groins underwent percutaneous and 44/146 (27%) surgical access. An average 2.2 devices per access site was used. Technical success was 95% (114/120). Local complications (3.3% vs. 11.4%, P=0.05), procedural times (90 vs. 112 min, P=0.05), hospitalization (2 vs. 5 d, P<0.001), and postoperative analgesics (0.7 vs. 4.4 g IV paracetamol, P=0.01) were significantly reduced after percutaneous access which overall seems safe and effective to perform EVAR.
authors.affiliation: *Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery †Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kontopodis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
authors.forename: Elias
authors.initials: E
authors.lastname: Kehagias
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Daskalakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Galanakis
authors.forename: Christos V
authors.initials: CV
authors.lastname: Ioannou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome