Fascial Suture Technique Vs. Open Femoral Access for Thoracic Endovascular Aortic Repair

Abstract

Introduction: Fascial suture technique (FST) has proved to be a safe and effective access closure technique following endovascular repair of the abdominal aorta. FST has not yet been investigated for closure of large bore access after thoracic endovascular aortic repair (TEVAR). The aim of this study is to compare FST with open femoral access in terms of access safety, haemostasis efficacy and re-intervention rate after TEVAR. Methods: A retrospective study including consecutive patients undergoing TEVAR with either FST or open femoral access between January 2010 and April 2016 was undertaken. Exclusion criteria included the use of closure devices. Composite primary endpoint was defined as any access-related complication (bleeding, femoral artery stenosis or occlusion, pseudoaneurysm, and wound infection) during 30-post-operative days. Preoperative and procedural variables were examined in a multiple logistic regression model as potential associated factors with access morbidity. All access vessels were postoperatively examined by clinical examination and computed tomography angiography (CTA) before discharge as well as during follow up period. In case of suspected pseudoaneurysm, additional duplex ultrasound and CTA confirmed the diagnosis. Results: From a total of 206 patients undergoing TEVAR, 109 (53%) had a FST, while 93 (45%) had an open femoral access. Four patients were excluded: closure device was used in one, one had primary conversion after percutaneous puncture without FST and in two no data was available about the femoral access. The access complication rate was higher in FST (FST; 14 (13%) vs. open access; 3 (3%), P=0.01). Five (4.6%) patients needed early re-intervention: two for bleeding and three for vessel occlusion. Seven (6.4%) pseudoaneurysms were detected during 30-day period in the FST group: three had successful exclusion with thrombin injection, one was treated with manual compression, one with open repair and two conservatively. Four (3.6%) patients in the FST group and three (3%) patients in the open access group had wound complications. After multiple logistic regression FST was the only independent factor for any access complication (OR 5.176, CI 1.402-19.114, P=0.014). During follow-up neither new pseudoaneurysm nor stenosis/occlusion were detected. Conclusion: Fascial suture technique for large hole closure after thoracic endovascular aortic repair had higher risk for any access complication compared with open access in TEVAR during the 30-day post-operative period. No other complications during 12 months follow-up were observed in FST patients.