The Superficial Femoral Artery: An Alternative Access for Percutaneous Endovascular Aneurysm Repair.
BACKGROUND
The aim of this study was to report the results of percutaneous endovascular aortic aneurysm repair (PEVAR) using the superficial femoral artery (SFA) for large bore vessel access.


METHODS
We reviewed all PEVAR procedures at our institution over an 18-month period, identifying all patients who underwent PEVAR with the use of one or both SFAs for endograft delivery with dual ProGlide large bore access closure. Indications for use of the SFA instead of the common femoral artery (CFA) included morbid obesity, CFA vessel wall disease, and scarring from previous CFA surgery.


RESULTS
In total, 158 percutaneous access closures were performed in 79 patients. Ten patients had one or both SFAs used. We accessed a total of 13 SFAs: 6 for the endograft main body (size range 18- to 20-French) and 7 for the limb (14- to 16-French). The freedom from open conversion was 84.6%. In comparison, of 145 CFA accesses (in 76 patients) there were 9 conversions (93.7% success). Of the 13 SFAs accessed, there were no major access site complications (pseudoaneurysm, access site bleed, limb ischemia, or need to return to the operating room). All SFAs accessed remained patent at the latest follow-up (range 1-13 months, median 8 months).


CONCLUSIONS
Our preliminary case series suggests that, in the absence of a healthy or percutaneously accessible CFA, a healthy SFA may be considered for PEVAR access. While likely carrying a higher risk of open conversion, this technique, when combined with intraoperative duplex ultrasound (both before and after the procedure) and with meticulous ultrasound-guided vascular access, appears safe for up to 20-French device diameters.
Department of Surgery, University of Minnesota, Minneapolis, MN; Minneapolis Veterans Health Care System, Minneapolis, MN.
Ashley
A
Aaron
Department of Surgery, University of Minnesota, Minneapolis, MN.
Selma
S
El-Hag
Department of Surgery, University of Minnesota, Minneapolis, MN.
Eileen
E
de Grandis
Department of Surgery, University of Minnesota, Minneapolis, MN; Minneapolis Veterans Health Care System, Minneapolis, MN.
Steve
S
Santilli
Minneapolis Veterans Health Care System, Minneapolis, MN; Department of Radiology, University of Minnesota, Minneapolis, MN.
Michael
M
Rosenberg
Department of Surgery, University of Minnesota, Minneapolis, MN.
Susan M
SM
Shafii
Minneapolis Veterans Health Care System, Minneapolis, MN; Department of Radiology, University of Minnesota, Minneapolis, MN.
Jafar
J
Golzarian
Department of Surgery, University of Minnesota, Minneapolis, MN. Electronic address: rfaizer@umn.edu.
Rumi
R
Faizer
D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D061887:Conversion to Open Surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D008910:Minnesota; D011474:Prosthesis Design; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices