Percutaneous access planning, techniques and considerations for endovascular aortic repair (EVAR)

Abstract

Percutaneous endovascular aortic repair (EVAR) has transformed the field of aortic repair. As techniques and devices improve, interventionalists continue to expand the boundaries of what is possible, enabling these life-saving procedures to be performed on a wider range of more technically challenging cases. This article discusses endovascular access considerations for EVAR including; ultrasound guidance, preclose technique, access vessel options, innovative devices, and bailout strategies that interventionalists should be familiar with to optimize patient outcomes.

Giant Pseudoaneurysm in Distal Anastomosis of Prosthetic Aorto-Femoral Bypass

“…10 However, the placement of stent graft in the femoral region, especially common femoral artery, is very risky as femoral artery is the most frequent access site for endovascular procedures. 11 The anatomical changes in the femoral artery during movement pose a high risk of stent-graft fracture, rupture and further arterial damage. 2,12…”

Incidence, predictors, impact, and treatment of vascular complications after transcatheter aortic valve implantation in a modern prospective cohort under real conditions

“…Other access-site considerations and strategies have been described. In case of unfavorable anatomy, surgical conduits techniques can be performed through the axillary artery or the retroperitoneal iliac artery (34). Too, the « paving and cracking » tecnhique using covered stents improves iliac access by dilation and relining of calcified and/or tortuous arteries (34)(35).…”

Percutaneous Endovascular Aneurysm Repair: Current Status and Future Trends

“…Vatakencherry et al have shown that infrainguinal access can be safely and effectively performed with Preclose technique by puncturing an adequately sized superficial femoral or profunda femoris artery in cases of high femoral bifurcation. 22 However, in some cases, upper extremity access may prove necessary. Brachial artery puncture can provide large bore access to the aorta from a cephalad approach.…”