Print this pageTotal Percutaneous Access For Endovascular Aortic Aneurysm Repair
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Michael P Brown*, Peter Nelson, W. Anthony Lee
University of Florida, Gainesville, FL
Introduction and Objectives:
Percutaneous access during endovascular aneurysm repair has been difficult due to the size of the delivery catheters. We describe a technique to close an arteriotomy after percutaneous access using large diameter introducer sheaths up to 24 French (F) in diameter.
Methods:
The technique involves deploying two 6 F Perclose Proglide devices over a wire after percutaneous access of the femoral artery. Each device deploys a single monofilament suture on either side of the puncture site. The pair of sutures is separated 60 degrees from each other, their free ends tagged, and left extracorporeally. Arterial access is maintained by re-inserting the guidewire prior to removal of the Proglide device. At the end of the EVAR procedure, the arteriotomy is approximated by “cinching-down” on the preformed knot and applying manual compression to the puncture site for 5-minutes while anticoagulation is reversed.
Results:
The medical records of 117 consecutive patients (62 EVAR, 51 thoracic EVAR, 4 iliac artery interventions) that had percutaneous arteriotomy closure with the Perclose device during EVAR were reviewed. One hundred seventy six (176) femoral arteries were closed with 351 Perclose devices. The sheath sizes used during these procedures ranged from 12 to 24 F. There were 4 immediate failures requiring open repair of two femoral arteries and emergent placement of a covered stent in two arteries. The success rate for percutaneous arteriotomy closure was 97%.
Conclusions:
Pre-deployment of 2 Proglide devices is effective in closure of femoral arteriotomies after percutaneous access using large diameter sheaths.
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