Total Percutaneous Endovascular Aneurysm Repair with the Dual 6-F Perclose-AT Preclosing Technique: A Case-control Study
Received 6 February 2009; received in revised form 12 June 2009; accepted 29 June 2009. published online 20 August 2009.
Purpose
To determine the safety and efficacy of total percutaneous access closure for endovascular aortic aneurysm repair with a suture-mediated preclosing technique.
Materials and Methods
One hundred thirty-two femoral access sites in 70 patients who underwent endovascular aortic aneurysm repair were closed percutaneously with off-label use of two F-6 Perclose AT devices preapplied at a 90° angle. Femoral access sizes ranged from 12 to 24 F. Technical success, complications, and procedure and access closure times were evaluated. Follow-up with computed tomography and/or magnetic resonance imaging was scheduled at 1–4 days and 3, 6, and 12 months and used to obtain groin hematoma and scar severity scores (grades 1–3). Data were compared with those from a cohort of 67 patients who underwent endovascular aortic aneurysm repair with surgical femoral cutdown.
Results
Technical success was achieved with the preclosing technique in 127 of the 132 arteries (96.2%). Two to four closure devices were used per groin. Five technical failures were managed intraoperatively with surgical suture. There was no access-related mortality and no late groin complications. The mean procedure duration was 91 minutes ± 32, and the mean access closure time was 12 minutes ± 9. For surgical management, the mean procedure time was 153 minutes ± 112 (P < .05), and the mean closure time was 12 minutes ± 13 (not statistically significant). Hematoma severity score at 1–4 days was 1.8 for total percutaneous endovascular aneurysm repair and 2.1 for surgical closure. Scar severity scores at 3, 6, and 12 months were 1.1, 1.0, and 1.0 for total percutaneous endovascular aneurysm repair and 2.4, 2.4, and 2.3 for surgical management, respectively.
Conclusions
Total percutaneous endovascular aneurysm repair with a dual 6-F-Perclose preclosing technique is safe and effective. Compared with femoral cutdown, there are fewer late groin complications and scar tissue formation is less severe.
aDepartment for Diagnostic Radiology, Christian-Albrechts-Universität Kiel, Arnold-Heller Str. 9, 24105 Kiel, Germany
bDepartment for Cardiothoracic and Vascular Surgery, Christian-Albrechts-Universität Kiel, Arnold-Heller Str. 9, 24105 Kiel, Germany
cInstitut für Diagnostische Radiologie und Neuroradiologie, Diako Flensburg, Germany
Address correspondence to T.J.
From the 2008 SIR annual meeting.
None of the authors have identified a conflict of interest.
ABSTRACT