Haemostasis for 568 large femoral artery access sites - outcomes and predictors of success

Abstract

The introduction of stent grafts for thoracic and abdominal aorta (T / EVAR) has raised the demand for percutaneous closure devices for larger femoral arterial access sites. The aim of our study was to evaluate the success and complication rate of completely percutaneous T / EVAR with Prostar XL® and surgical haemostasis over a 50- month period. Between December 16th 2005 and February 17th 2010 T / EVAR was performed in 306 patients with 568 arterial access sites with diameters of 12 to 24 Fr. The exclusion criteria for percutaneous haemostasis were a calcified anterior wall at the puncture site and / or a stenotic common femoral artery, seen on computed tomographic angiography. Surgical haemostasis was performed in 184 (32.4 %, o-T / EVAR group) while percutaneous haemostasis was attempted at 384 sites (67.6 %, p-T / / EVAR group). Most of the procedures were elective; five of twelve emergency patients had percutaneous haemostasis that was successful in all. Percutaneous haemostasis failed at 23 sites. No data about follow-up was recorded for 54 sites (9,5 %). The technical success rate of percutaneous haemostasis was 93.6 % (338 / 361 sites). A larger size of the access site resulted in significantly more complications of haemostasis in both groups (p-T / EVAR group p = 0.019; o-T / EVAR group p = 0.003). p-T / EVAR caused more mild complications compared to o-T / EVAR (p = 0.03). No deaths as consequence of failed haemostasis were recorded. Complete percutaneous T / EVAR is technically feasible and safe in a majority of patients. Good patient selection based on adequate pre-procedural imaging and technical expertise of the operators are key to success. Surgical back-up is strongly recommended to assist in those patients in whom p-T / EVAR fails.