Percutaneous endovascular abdominal aortic aneurysm repair leads to a reduction in wound complications

McDonnell, Caoimhe; Forlee, Martin; Dowdall, J. F.; Colgan, Mary-Paula; Madhavan, Prakash; Shanik, Gregor D.; Moore, Dermot J.

doi:10.1007/s11845-008-0122-6

Cited by 22 publications

(30 citation statements)

References 9 publications

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“…However, our study demonstrates that performing a concomitant procedure is a predictor of percutaneous access failure. A significantly decreased mean total operative time 2–8 and a shorter length of hospital stay 3, 6, 9, 10 were noted in many previous studies in pEVAR patients when compared to cEVAR patients. Prior studies have noted wound complications ranging from 0–11% 9, 14 with a rate of 5.0% 2 noted in the randomized trial.…”

Section: Discussionmentioning

confidence: 52%

“…2 Several small single center studies using a variety of grafts showed a reduction in total operative time 2–8 and length of hospital stay. 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.…”

Section: Introductionmentioning

confidence: 92%

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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: 52%

Section: Introductionmentioning

confidence: 92%

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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“…Previously published studies have reported success rates varying from 71% to 100% for percutaneous closure after endovascular aneurysm repair. [2,3,5,14–19] Our 95% technical success rate was at the high end of this range. Previous studies noted various factors associated with percutaneous closure failure, including a small-diameter access vessel, certain types of closure devices, femoral artery calcification, access vessel tortuosity, and groin scars.…”

Section: Discussionmentioning

confidence: 78%

Feasibility and safety of total percutaneous closure of femoral arterial access sites after veno-arterial extracorporeal membrane oxygenation

Liu

Han

et al. 2019

Medicine

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To evaluate the safety and efficacy of total percutaneous closure of the femoral artery access site after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with the Perclose ProGlide device.This retrospective observational study during an almost 2-year period included 21 patients who underwent VA-ECMO in whom the femoral artery puncture site was closed percutaneously with Perclose ProGlide devices. Technical success was defined as successful arterial closure of the common femoral artery, without the need for additional surgical or endovascular procedures. Access site complications were recorded at 24 hours and 30 days after arterial closure, such as major bleeding requiring transfusion or surgical intervention, minor bleeding, groin infection, pseudoaneurysm, and lymphocele.Technical success was achieved in 20 patients (95.2%). One patient required surgical repair for an access site pseudoaneurysm. Eighteen femoral arteries were closed with 2 devices each, while 3 patients required the use of a third device for femoral artery access site closure to achieve adequate hemostasis. No arterial thrombosis, arterial dissection, arterial stenosis, groin infection, or arteriovenous fistula occurred during the periprocedural period (within 24 hours of arterial closure) or during 30-day follow-up.Percutaneous closure with the Perclose ProGlide device is a feasible procedure for closing femoral arterial access sites after VA-ECMO, with a low incidence of access site complications.

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“…6 However, impact on LOS has been modest, with a mean of 3.5 days in open access compared to 2.7 days in those who had PEVAR in studies comparing both approaches. [7][8][9] The overall cost of EVAR has been reported to be higher than open repair mainly due to device costs, surveillance imaging and reinterventions 10,11 ; however, the cost analysis of the Open vs Endovascular Repair (OVER) trial reported that in-hospital costs were lower with EVAR persisting up to 2 years. 12 Since device costs are somewhat fixed, decreasing intensive care and overall hospital LOS and wound complications would further decrease the cost of EVAR.…”

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confidence: 99%