Follow-Up of Fascial Suture After Endovascular Aneurysm Repair with Duplex Ultrasound

Abstract

Introduction: Fascia suture is an alternative technique for femoral artery access site hemostasis after endovascular aneurysm repair (EVAR).1,2 Vascular complications such as pseudo-aneurysm formation and stenosis in the femoral artery after fascial suture are a challenge. The aim of the study was to report the incidence and clinical outcome of access related vascular injury and subsequent intervention after fascial suture technique using duplex ultrasound pre-operatively and three months post-operatively. Methods: Between February 1st 2011 and July 31st 2014, all patients who underwent EVAR with attempted fascial suture were included. During the study period, 245 patients underwent EVAR, 3 were unilateral and thus 487 groins were examined of which 175 groins were excluded leaving 312 groins for further analysis. The reason for exclusion were planned cut-down (n = 51), closure device (n = 14) and cut-down due to surgeons preferences (n = 110), mainly due to heavily calcified common femoral arteries (n = 92). Data were prospectively collected and retrospectively analyzed. The access arteries were investigated with duplex ultrasound pre-operatively and after three months. A peak systolic velocity ratio of two or higher defined significant stenosis. Online medical records were used to identify primary failures, reoperations and re-hospitalization related to femoral artery access site within three months. Results: Fascia closure failed in 29 groins out of 312 and at three month follow-up of the remaining 283 groins no patients suffered stenotic lesions at the access site and pseudo-aneurysm formation was seen in 13 patients, of which one had thrombin injection and 12 were treated conservatively. Between discharge and three month follow-up, one patient with pedal pulses after EVAR suffered from acute limb ischemia and was treated successfully with a cross-over bypass. Wound infections were seen in seven patients, needing surgical revision in four. Conclusion: Fascia suture in EVAR is associated with a low complication rate, excellent clinical outcomes and can be performed in two third. Access site stenosis did not occur in this study and pseudo-aneurysm formations were infrequent and benign. Disclosure of Interest: None Declared.