Retrospective Evaluation of Percutaneous Access for TEVAR and EVAR: Time to Make it the Standard Approach?
IntroductionTo evaluate the safety of percutaneous endovascular aortic repair and the relationship of access site characteristics to complicationsMaterials and MethodsAll patients undergoing percutaneous TEVAR, EVAR and FEVAR procedures from January 2010 to May 2016 were retrospectively analysed for incidence of complications and their relationship to various access site characteristics like access artery size, degree of vessel calcification, skin to artery distance and sheath to artery ratio. Hemostasis occurring within 15 min after suture closure with or without manual compression was defined as primary hemostasis.Results92 patients with 142 femoral access sites were included in the study. Median follow-up was 28.13 months (range 2.5 - 76.7 months, Mean 32.39, SD - 21.66 months). Introducer system size ranged from 12F to 25F. Primary haemostasis was achieved in 97.1 % (138/142) of the total femoral access sites. Four access sites (2.8 %) had to be closed surgically; in all 4 cases the introducer systems was ≥ 18F. Two of these access sites had been operated upon previously. Late complications including inguinal hematoma (n = 7), wound infection (n = 1), scrotal hematoma (n = 1), pseudoaneurysm (n = 4) and late bleeding (n = 4) occurred in 17 access sites (11.9 %), of which 13 were managed conservatively. On account of the low complication rate, no correlation between the evaluated variables and observed complications could be established.ConclusionPercutaneous endovascular aortic repair is feasible and safe irrespective of the size of the introducer sheath and the nature of aorto-iliac pathology. The technical success rate is high and the incidence of complications is low. Early complications are most often associated with sheath sizes ≥ 18 F. The majority of the late complications can be treated conservatively.Key points:· Percutaneous endovascular aortic repair is feasible and safe.. · Technical success rate is high and complication rate is low.. · Vascular closure device failure in the occasional patient may necessitate surgical intervention..Citation Format· Thomas RP, Kowald T, Schmuck B et al. Retrospective Evaluation of Percutaneous Access for TEVAR and EVAR: Time to Make it the Standard Approach?. Fortschr Röntgenstr 2017; 189: 347 - 355.
Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany.
Rohit Philip
RP
Thomas
Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany.
Tobias
T
Kowald
Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany.
Bernhard
B
Schmuck
Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany.
Osama
O
Eldergash
Department of Anaesthesia, Intensive care medicine, Emergency medicine and Pain therapy, University Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany.
Andreas
A
Klausen
Department of Cardiac Surgery, University Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany.
Valentin
V
Dikov
Department of Cardiac Surgery, University Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany.
Jerry
J
Easo
Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany.
Ajay
A
Chavan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome