Backgrounds Aortic diseases have been diagnosed and studied for centuries. In the current era, endovascular therapy with percutaneous stent-graft placement has become a viable therapeutic option and will surely improve with continuing technological advances. As technology trends towards less invasive, a truly percutaneous therapy would be desirable. We describes and reports a Preclosing technique for femoral access sites management without groin incisions.
Methods From Oct 2009 to May 2010, consecutive 70 patients (63 males; mean age: 61.4±7.4 years) underwent endovascular repair for aortic dissections (n=46) and thoracic (n=3) or abdominal aortic aneurysms (n=21) using the Preclosing technique. Preprocedural CTA was performed to assess the suitability of common femoral artery anatomy. Endografts used included Zenith (Cook, USA), Valiant (Medtronic, USA), Hercules (Microport, China). This technique was applied to 86 femoral sites in 66 patients, five access sites was managed surgically. After puncture of common femoral artery, followed by deployment of two Percloses Proglide Devices (6Fr, Abbott Vascular Devices, USA) at about 60°angle, arteriotomies were dilated to an appropriate size (larger than 16Fr). After removal of the sheath at the end of the procedure, haemostasis was achieved by knotting the multiple Proglide Perclose sutures placed prior to arterial dilatation. If immediate haemostasis could not be achieved, one more Perclose device was deployed. Femoral sites and limb circulation were examined immediately after suture and following days. Technical success, complications, procedure and anaesthesia times were evaluated.
Results Technical success was achieved in all access sites. During hospitalisation there were no access-related complications. Procedure duration and anaesthesia time was shorter. 179 Perclose devices were used to close 86 femoral access sites. Profiles of stent-graft delivery devices used were 16 Fr (n=20), 20 Fr (n=14), 21 Fr (n=28), 22 Fr (n=21), 24 Fr (n=7).
Conclusions This study confirms that complete percutaneous endovascular aortic repair using the Preclosing technique is safe and effective, compared with femoral incision, it saves procedure and anaesthesia and hospitalisation time, and expected to reduce blood loss and late complications and scar tissue formation. we suggest the technique be performed at hospitals where vascular surgery is available in case of emergent complications. Patient selection as well as the technique of deploying the Perclose devices is key to the procedure success.
- Endovascular aortic repair
- preclosing technique