A single-centre experience of 200 consecutive unselected patients in percutaneous EVAR

Petronelli, S; Zurlo, Maria Teresa; Giambersio, Silvia; Danieli, Lucia; Occhipinti, Mariaelena

doi:10.1007/s11547-014-0399-7

Cited by 8 publications

(14 citation statements)

References 30 publications

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“…Among prior published reports we found success rates for pEVAR varying from 71% to 100%. 2–12, 14–16 In addition to access vessel diameter and type of closures device, femoral artery calcification, access vessel tortuousity and groin scars have all been associated with pEVAR failure. 8, 17, 18 Unfortunately, this database does not provide anatomic information about femoral artery calcification, access vessel diameter and previous groin operations.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed conflicting results regarding the influence of obesity on pEVAR success rates. Some studies suggest an association between obesity and technical failure of pEVAR 4, 7, 18, 22 , while others found that obesity had no influence on the pEVAR success rate 8, 12, 14, 17 . In particular, those studies employing routine use of ultrasound scan-guided pEVAR were more likely to note the lack of association of obesity with success 8, 16, 23 .…”

Section: Discussionmentioning

confidence: 99%

“…3, 6, 9, 10 Additionally, access-related complication rates were lower with pEVAR compared to cEVAR. 2, 4, 6–12 Despite these promising results, the possibility of publication bias should be considered. Therefore a larger scale study, of contemporary management of AAA comparing pEVAR and cEVAR, is needed to see if the results from the prior RCT and single centers may be generalizable.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous versus femoral cutdown access for endovascular aneurysm repair

Buck

Karthaus

Soden

et al. 2015

Journal of Vascular Surgery

104

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Objective Prior studies suggest that percutaneous access for endovascular abdominal aortic aneurysm repair (pEVAR) offers significant operative and post-operative benefits compared to femoral cutdown (cEVAR). National data on this topic, however, are limited. We compared patient selection and outcomes for elective pEVAR and cEVAR. Methods We identified all patients undergoing either pEVAR (bilateral percutaneous access whether successful or not) or cEVAR (at least one planned groin cutdown) for abdominal aortic aneurysms (AAA), from January 2011 to December 2013 in the Targeted Vascular dataset from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Emergent cases, ruptures, cases with an iliac conduit, and cases with a preoperative wound infection were excluded. Groups were compared using chi-square test or t-test or the Mann-Whitney test where appropriate. Results 4112 patients undergoing elective EVAR were identified; 3004 cEVAR (73%) and 1108 pEVAR (27%). Of all EVAR patients 26% had bilateral percutaneous access, 1.0% had attempted percutaneous access converted to cutdown (4% of pEVARs), while the remainder had a planned cutdown, 63.9% bilateral, and 9.1% unilateral. There were no significant differences in age, gender, aneurysm diameter or prior open abdominal surgery. Patients undergoing cEVAR were less likely to have congestive heart failure (1.5% vs. 2.4%, P=0.04) but more likely to undergo any concomitant procedure during surgery (32% vs. 26%, P<.01) than patients undergoing pEVAR. Postoperatively, pEVAR patients had shorter operative time (mean 135 vs. 152 minutes, P<.01), shorter length of stay (median 1 day vs. 2 days, P<.01), and fewer wound complications (2.1% vs. 1.0%, P=0.02). On multivariable analysis the only predictor of percutaneous access failure was performance of any concomitant procedure (OR 2.0, 95% CI 1.0–4.0, P=0.04). Conclusions Currently, 1 in 4 patients treated at Targeted Vascular NSQIP centers are getting pEVAR, which is associated with a high success rate, shorter operation time, shorter length of stay, and fewer wound complications compared to cEVAR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous versus femoral cutdown access for endovascular aneurysm repair

Buck

Karthaus

Soden

et al. 2015

Journal of Vascular Surgery

104

View full text Add to dashboard Cite

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“…The two types of SMCD that were used in the reviewed studies were Prostar XL and the Proglide system. Prostar XL was used in 27 studies, 16,17,[20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][37][38][39][40][41][43][44][45][46] and Proglide was used in 6 studies. 18,20,[27][28][29]42 In three studies, 20,27,29 both Prostar and Proglide devices were used.…”

Section: Results Of Smcdmentioning

confidence: 99%

“…18,20,[27][28][29]42 In three studies, 20,27,29 both Prostar and Proglide devices were used. The rates of technical success by access site ranged between 63 and 100%, but with only two articles 34,37 reporting rates below 80% and most articles [16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33]35,36,[38][39][40][41][42][43][44][45][46] reporting rates between 89 and 100%. The rates of technical success by patient ranged between 53 and 100%, but with only three articles reporting rates below 80% 22,34,35 and most articles reporting rates between 89 and 100%.…”

Section: Results Of Smcdmentioning

confidence: 99%

Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review

et al. 2018

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The aim of the present study is to review the available data on suture-mediated closure devices (SMCDs) and fascia suture technique (FST), which are alternatives for minimizing the invasiveness of percutaneous endovascular aortic aneurysm repair (p-EVAR) and reduce the complications related to groin dissections. The Medline, ClinicalTrials.gov, and Cochrane library - Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for publications regarding SMCD and FST between January 1999 and December 2016. We review 37 original articles, 30 referring to SMCDs (Prostar XL and Proglide), which included 3,992 patients, and 6 articles referring to FST, which include 426 patients. The two techniques are compared only in one article (100 patients). The two types of SMCDs were Prostar and Proglide. In most studies on SMCDs, the reported technical success rates were between 89 and 100%, but the complication rates varied greatly between 0 and 25%. Concerning FST, the technical success rates were also high, ranging between 87 and 99%. However, intraoperative complication rates ranged between 1.2 and 13%, whereas postoperative complication rates varied from 0.9 to 6.2% for the short-term and from 1.9 to 13.6% for the long-term. SMCDs and FST seem to be effective and simple methods for closing common femoral artery (CFA) punctures after p-EVAR. FST can reduce the access closure time and the procedural costs with a quite short learning curve, whereas it can work as a bailout procedure for failed SMCDs suture. The few failures of the SMCDs and FST that may occur due to bleeding or occlusion can easily be managed.

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Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

et al. 2016

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Postoperative mortality was 6.3 % in the wIFU group while it was 7.8 % in the oIFU group. There was not a statistically significant difference in the rate of postoperative mortality (p = 0.653). Technical success was 98.6 % in the wIFU group while it was 94.5 % in the oIFU group. All the patients of the wIFU group were treated with a stent-graft with under-renal sealing while in the oIFU group always an over-renal stent-graft was used. No deaths related to the aneurysm were highlighted at follow-up in both groups. There was a statistically significative difference between the two groups regarding intraoperative occlusion of renal arteries (wIFU = 1.1 %; oIFU = 4.7 %; p < 0.05) and in the development of type I endoleak (wIFU = 2.8 %; oIFU = 8.8 %; p < 0.05) CONCLUSION: EVAR in patients with hostile neck is feasible and effective with an acceptable rate of complications.

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A single-centre experience of 200 consecutive unselected patients in percutaneous EVAR

Abstract: Percutaneous endovascular aneurysm repair in "unselected" patients is safe and efficient, with a very low risk of access-related complications, comparable to P-EVAR in selected populations and to the best O-EVAR series.

Cited by 8 publications

References 30 publications

Percutaneous versus femoral cutdown access for endovascular aneurysm repair

Percutaneous versus femoral cutdown access for endovascular aneurysm repair

Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review

Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

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