Percutaneous repair of abdominal aortic aneurysms using the AneuRx stent graft and the percutaneous vascular surgery device

Abstract

Endovascular exclusion of abdominal aortic aneurysms (AAAs) was developed in an effort to treat patients who were at high risk for complications following standard surgical repair. Stent grafts used for endovascular repair of AAAs require the use of large-bore sheaths and surgical exposure of the common femoral arteries (CFAs). To decrease the invasiveness of AAA repair, we attempted to perform the procedure percutaneously utilizing the Prostar XL Percutaneous Vascular Surgery Device and the preclose technique. Thirty patients underwent an attempted percutaneous AAA repair. These patients were followed prospectively to assess the success of the procedure. Twenty-eight patients (93%) had successful percutaneous repair of both CFA access sites. One patient had inadequate hemostasis of the 22 Fr CFA entry site and one patient had inadequate hemostasis of the 16 Fr CFA entry site. Both of these CFA sites underwent open surgical repair. The rate of successful repair of the 22 Fr CFA access site was 29 of 30 (96%); for the 16 Fr CFA access site, 29 of 30 (96%). No in-hospital groin complications were seen. The procedure time was 105 +/- 21 min. The estimated blood loss was 90.6 +/- 50 cc. The hemoglobin loss was 1.54 +/- 0.89 mg/dL and the hematocrit loss was 5.04% +/- 2.8%. Complete percutaneous endoluminal AAA repair is feasible using the preclose technique. CFAs with sheaths up to 22 Fr can be safely and successfully accessed and repaired percutaneously using this technique. This method provides secure hemostasis and reduces the invasiveness of procedures requiring large-bore sheaths.

Percutaneous closure of femoral artery access sites in endovascular stent-graft treatment of aortic disease

“…Vascular complications are rare [14]. In previous studies, investigators introduced the so called "Pre-closure" technique for large-bore arteriotomies using percutaneous closure devices [7][8][9][10][15][16][17]. This technique originated from the modified percutaneous approach in 1997, which included a short incision and 3-0 suture through the fascia for safe sheath removal [15].…”

“…Vascular complications using 6 Fr Perclose devices are uncommon and include failed hemostasis with hematoma, infection, pseudoaneurysm, device malfunction, or arterial thrombosis [14]. Because endovascular techniques for aortic diseases require large-bore vascular access, suture-mediated percutaneous closure has been International Journal of Cardiology 130 (2008) 251 -254 www.elsevier.com/locate/ijcard described using the "Pre-close technique" [7][8][9][10][15][16][17]. In previous studies [7,8,10,17], the Prostar XL percutaneous vascular device (Perclose, Menlo Park, CA) was used, but there is no study using the more popular and practiced suturemediated closure device, Closer-S.…”

“…The CFA exposure with surgical cut-down increases invasiveness and the risk of complications. However, since the development of arterial closure devices, several non-surgical methods for femoral artery access and closure have been reported [7][8][9][10]. Percutaneous suture devices for closure following diagnostic and therapeutic coronary and peripheral arteriography decrease time to ambulation and length of stay, and increase patient comfort [11][12][13].…”

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

“…Pre-operative radiological assessment of the iliofemoral vessels is essential to assess for calcification and tortuosity with high failure rates expected for patients who are obese or who have scarred groins [3]. Just 1 year later, Howell et al [5] reported a 93% success rate in their series. The progressively improving success rates are undoubtedly a reflection of the learning curve and while we are satisfied with our results to date, these may be a reflection of the relatively small numbers included in our series.…”

Efficacy and Safety of Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair

“…In light of this, percutaneous EVAR (p-EVAR) techniques have been developed. Further potential advantages of p-EVAR are reductions in operating time, blood loss, time to ambulation and hospital stay [3][4][5][6].…”