TY - JOUR
T1 - Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated–Branched Endovascular Aortic Repair of Pararenal–Thoracoabdominal Aortic Aneurysms
AU - D’Oria, Mario
AU - Oderich, Gustavo S.
AU - Tenorio, Emanuel R.
AU - Kärkkäinen, Jussi M.
AU - Mendes, Bernardo C.
AU - DeMartino, Randall R.
N1 - Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Introduction: We sought to evaluate the safety and efficacy of totally percutaneous femoral access (TPFA) for fenestrated–branched endovascular aortic repair (F/B-EVAR) of pararenal–thoracoabdominal aortic aneurysms (PRAs/TAAAs). Methods: We reviewed all consecutive patients enrolled in single-center prospective non-randomized single-arm study to investigate F/B-EVAR for PRAs/TAAAs (2013–2017). Percutaneous approach was selected in all patients when anatomically feasible; otherwise, surgical femoral access (SFA), with or without construction of temporary prosthetic conduit, was selected. Primary outcomes were technical success, mortality, major adverse events (MAEs) and major vascular access complications. Results: A total of 231 patients were included in the study: TPFA was possible in 163 (70%) with technical success rate of 93%, while 68 (30%) required SFA. Patients with TPFA and SFA had similar mortality rate of 1%. The rate of MAEs for TPFA was 20% versus 38% for SFA (p =.07). The trend was mainly driven by reduced rates of estimated blood loss (EBL) ≥ 1L (6% vs 21%, p =.001) and acute myocardial infarction (2% vs 9%, p =.03). Similarly, TPFA carried a significantly lower rate of major vascular access complications as compared with SFA (6% vs 21%, p <.001; adjusted OR 3.4, 95% CI 1.3–8.9, p =.01). Conclusion: A percutaneous-first approach for elective F/B-EVAR of PRAs/TAAAs is safe, feasible and effective when proper patient selection is provided. When the presence of hostile iliofemoral anatomy requires open-vessel exposure, higher rates of perioperative major bleeding, cardiac events and access complications may be expected. Level of Evidence: Level 3 (single-center prospective non-randomized single-arm study).
AB - Introduction: We sought to evaluate the safety and efficacy of totally percutaneous femoral access (TPFA) for fenestrated–branched endovascular aortic repair (F/B-EVAR) of pararenal–thoracoabdominal aortic aneurysms (PRAs/TAAAs). Methods: We reviewed all consecutive patients enrolled in single-center prospective non-randomized single-arm study to investigate F/B-EVAR for PRAs/TAAAs (2013–2017). Percutaneous approach was selected in all patients when anatomically feasible; otherwise, surgical femoral access (SFA), with or without construction of temporary prosthetic conduit, was selected. Primary outcomes were technical success, mortality, major adverse events (MAEs) and major vascular access complications. Results: A total of 231 patients were included in the study: TPFA was possible in 163 (70%) with technical success rate of 93%, while 68 (30%) required SFA. Patients with TPFA and SFA had similar mortality rate of 1%. The rate of MAEs for TPFA was 20% versus 38% for SFA (p =.07). The trend was mainly driven by reduced rates of estimated blood loss (EBL) ≥ 1L (6% vs 21%, p =.001) and acute myocardial infarction (2% vs 9%, p =.03). Similarly, TPFA carried a significantly lower rate of major vascular access complications as compared with SFA (6% vs 21%, p <.001; adjusted OR 3.4, 95% CI 1.3–8.9, p =.01). Conclusion: A percutaneous-first approach for elective F/B-EVAR of PRAs/TAAAs is safe, feasible and effective when proper patient selection is provided. When the presence of hostile iliofemoral anatomy requires open-vessel exposure, higher rates of perioperative major bleeding, cardiac events and access complications may be expected. Level of Evidence: Level 3 (single-center prospective non-randomized single-arm study).
KW - Fenestrated and branched endovascular aortic repair
KW - Pararenal aortic aneurysms
KW - Percutaneous access
KW - Thoracoabdominal aortic aneurysms
KW - Vascular closure device
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U2 - 10.1007/s00270-020-02414-8
DO - 10.1007/s00270-020-02414-8
M3 - Article
C2 - 31942649
AN - SCOPUS:85078602551
VL - 43
SP - 547
EP - 555
JO - CardioVascular and Interventional Radiology
JF - CardioVascular and Interventional Radiology
SN - 7415-5101
IS - 4
ER -