Abstract
PurposeTo investigate the predictors and treatment of the 6-Fr Perclose Proglide-related complications (PRC) in percutaneous endovascular aortic repair (pEVAR).MethodsWe retrospectively analyzed the PRC after pEVAR for the treatment of aortic aneurysm or dissection in our center from December 2012 to November 2013. Procedure success was defined as effective functioning of the two devices and local hemostasis. Access-related adverse events included vascular complications and device failures. Operative data and angiographic and computed tomography images were collected to assess the complications and treatment strategy.ResultsA total of 198 patients with 275 puncture sites underwent pEVAR with the 6-Fr Perclose Proglide. The procedure was successful in 178 patients (89.9%), whereas PRC occurred in 20 cases (10.1%), including 10 device failures and 10 vascular complications. An extra manual ancillary compression was conducted in 7 patients, one more device was used in 8 patients, and surgical repair of the femoral artery was performed in 5 patients. PRC had a tendency to occur in patients with body mass index (BMI)>30 kg/m2 (p = 0.021), thoracic stent grafts (p = 0.038), common femoral artery (CFA) calcification (p = 0.001), CFA depth>4 cm (p = 0.001), and sheath size>20Fr (p = 0.005). Device failure-related mortality was zero. None of the access sites had complications during the midterm follow-up.ConclusionsThe pre-close technique with 6-Fr Perclose Proglide devices for pEVAR appears to be safe and effective with low technical failure and complication rates. Careful patient selection and proficiency in device manipulation might reduce the device related complications.
Highlights
Endovascular aortic repair (EVAR) has been an option for the treatment of aortic diseases, such as dissections[1] and aneurysms[2,3]
An extra manual ancillary compression was conducted in 7 patients, one more device was used in 8 patients, and surgical repair of the femoral artery was performed in 5 patients
Proglide-related complications (PRC) had a tendency to occur in patients with body mass index (BMI)>30 kg/m2 (p = 0.021), thoracic stent grafts (p = 0.038), common femoral artery (CFA) calcification (p = 0.001), CFA depth>4 cm (p = 0.001), and sheath size>20Fr (p = 0.005)
Summary
Endovascular aortic repair (EVAR) has been an option for the treatment of aortic diseases, such as dissections[1] and aneurysms[2,3]. Since the advent of “pre-close technique” advocated by Haas et al.[4], percutaneous EVAR (pEVAR) has been applied to decrease the morbidity of the groin incisions. Six-Fr Perclose Proglide (Abbot vascular, Redwood City, USA) is one of these vascular suture devices that consists of one 3–0, unbraided, pre-tied slipknot. A greater than 90% success rate has been reported for this device, and the technique can save procedure time, reduce hospitalization duration, and promote early ambulation[5,6,7]. Because of inherent limitations and the learning curve involved in its use, several 6Fr Perclose Proglide-related complications (PRC) remain unsolved[8,9]. The current study was conducted to investigate the procedural success rate and predictors of PRC in pEVAR
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