TY - JOUR
T1 - Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts
AU - De Souza, Leonardo R.
AU - Oderich, Gustavo S.
AU - Banga, Peter V.
AU - Hofer, Janet M.
AU - Wigham, Jean R.
AU - Cha, Stephen
AU - Gloviczki, Peter
N1 - Funding Information:
Additional material for this article may be found online at www.jvascsurg.org . Appendix (online only) Supplementary Fig 1 (online only) The ultrasound guidance secures a puncture proximal to the femoral bifurcation and in the anterior wall of the artery. Whether to perform the puncture using a (A) transverse or a (B) longitudinal view is the surgeon's preference. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Supplementary Fig 2 (online only) Preoperative imaging evaluation and adequate patient selection are necessary to obtain satisfactory results. A and B, Areas with severe and circumferential calcification are avoided and may be a contraindication to the total percutaneous procedure. C, A high femoral artery bifurcation requires additional care to avoid distal punctures. Supplementary Fig 3 (online only) A, A small oblique incision is made. B, The subcutaneous tissue is dilated circumferentially to facilitate placement of the percutaneous vascular closure devices (PVCDs) and to avoid the inclusion of subcutaneous tissue in the suture. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Supplementary Fig 4 (online only) A, It is important that both of the devices be introduced at the 12:00 o'clock position and at a ∼45° angle from the skin. B, After confirmation that the device is inside the vessel, the first one should be rotated to the 10:30 o'clock position before the following steps for its complete delivery. C, The second device is introduced in the same fashion as the first one but is rotated to the 1:30 o'clock position. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Supplementary Fig 5 (online only) A , Obtaining adequate sealing of the large-sheath device arterial puncture is expected when two devices are used; however, a series of mechanisms may act to promote the failure of the technique. Inadequate sealing may result from (B) partial or (C) total inclusion of the inguinal ligament in the suture. D, As it occurs in the open technique, anterior plaques may prevent the effective suture of the puncture. E and F, Similar to the inguinal ligament, the dermis and the subcutaneous tissue may be included in the suture. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.)
PY - 2015/12
Y1 - 2015/12
N2 - Objective Percutaneous endovascular aortic repair (PEVAR) has been increasingly used to treat infrarenal abdominal aortic aneurysms, but few studies have evaluated the results in complex aortic aneurysms. We reviewed the technical success and clinical outcomes of PEVAR using large-diameter sheaths for the treatment of complex aortic aneurysms with thoracic, fenestrated, and branched stent grafts. Methods The clinical data of patients who underwent total PEVAR for descending thoracic aneurysm, thoracoabdominal aortic aneurysm, pararenal, and aortoiliac aneurysms using thoracic, fenestrated, and branched stent grafts between 2009 and 2014 were reviewed. Repairs with fenestrated-branched stent grafts were performed using commercially available or investigational devices under a physician-sponsored investigational device protocols. Percutaneous closure was performed using ultrasound guidance and two Perclose devices (Abbott Vascular, Santa Clara Calif) per femoral puncture site. End points were technical success, access-related complications, morbidity, and mortality. Results There were 102 patients, 77 male and 25 female, with a mean age of 75 ± 8 years. Aneurysm extent was pararenal in 48 patients (47%), thoracoabdominal aortic aneurysm in 27 (26%), descending thoracic aneurysm in 19 (19%), and aortoiliac in 8 (8%). Fenestrated or branched endografts, or both, were placed in 72 patients (71%). Total percutaneous closure was performed in 170 femoral arteries using ≥20F-diameter sheaths in 163 (96%). Technical success was obtained in 161 femoral arteries (95%). There were no factors associated with technical failure. Access-related complications occurred in five patients (5%), including femoral artery thrombosis in three (3%), and retroperitoneal hematoma or pseudoaneurysm in one patient each (1%). There were no 30-day deaths. Freedom from access-related complications was 97% ± 1% at 30 days and 1 year. No access-related complications occurred >30 days. Conclusions Total percutaneous technique can be safely performed with a high technical success rate and low rate of access complications in patients with thoracic and complex aortic disease requiring large-diameter sheaths. The rate of access-related complications (5%) is similar to that reported for PEVAR of infrarenal abdominal aortic aneurysms using smaller-profile devices.
AB - Objective Percutaneous endovascular aortic repair (PEVAR) has been increasingly used to treat infrarenal abdominal aortic aneurysms, but few studies have evaluated the results in complex aortic aneurysms. We reviewed the technical success and clinical outcomes of PEVAR using large-diameter sheaths for the treatment of complex aortic aneurysms with thoracic, fenestrated, and branched stent grafts. Methods The clinical data of patients who underwent total PEVAR for descending thoracic aneurysm, thoracoabdominal aortic aneurysm, pararenal, and aortoiliac aneurysms using thoracic, fenestrated, and branched stent grafts between 2009 and 2014 were reviewed. Repairs with fenestrated-branched stent grafts were performed using commercially available or investigational devices under a physician-sponsored investigational device protocols. Percutaneous closure was performed using ultrasound guidance and two Perclose devices (Abbott Vascular, Santa Clara Calif) per femoral puncture site. End points were technical success, access-related complications, morbidity, and mortality. Results There were 102 patients, 77 male and 25 female, with a mean age of 75 ± 8 years. Aneurysm extent was pararenal in 48 patients (47%), thoracoabdominal aortic aneurysm in 27 (26%), descending thoracic aneurysm in 19 (19%), and aortoiliac in 8 (8%). Fenestrated or branched endografts, or both, were placed in 72 patients (71%). Total percutaneous closure was performed in 170 femoral arteries using ≥20F-diameter sheaths in 163 (96%). Technical success was obtained in 161 femoral arteries (95%). There were no factors associated with technical failure. Access-related complications occurred in five patients (5%), including femoral artery thrombosis in three (3%), and retroperitoneal hematoma or pseudoaneurysm in one patient each (1%). There were no 30-day deaths. Freedom from access-related complications was 97% ± 1% at 30 days and 1 year. No access-related complications occurred >30 days. Conclusions Total percutaneous technique can be safely performed with a high technical success rate and low rate of access complications in patients with thoracic and complex aortic disease requiring large-diameter sheaths. The rate of access-related complications (5%) is similar to that reported for PEVAR of infrarenal abdominal aortic aneurysms using smaller-profile devices.
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U2 - 10.1016/j.jvs.2015.07.072
DO - 10.1016/j.jvs.2015.07.072
M3 - Article
C2 - 26372191
AN - SCOPUS:84948712546
VL - 62
SP - 1442-1449.e3
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
SN - 0741-5214
IS - 6
ER -