Comparison of open femoral exposure and percutaneous access in endovascular reconstruction of the thoracic aorta: a two-center retrospective study
Open Access
- 13 September 2022
- journal article
- Published by Silicea - Poligraf, LLC in Russian Journal of Cardiology
- Vol. 27 (3S), 5135
- https://doi.org/10.15829/1560-4071-2022-5135
Abstract
Aim. To analyze the efficacy and safety of the percutaneous transfemoral puncture technique for TEVAR (thoracis endovascular aortic repair).Material and methods. The retrospective study included 89 patients with aortic pathologies, for whom endovascular repair was performed: 51 patients (57%) with aortic dissection (type I DeBakey — 30 cases (58,8%) and type III — 21 (41,2%)), 38 (43%) patients with aortic aneurism. 82% of patients were male, the median age was 57 years (minimum age 17 years, maximum age 75 years). All patients were divided into two groups: in the first group (48 patients) endovascular aortic repair was performed under endotracheal anesthesia with open femoral exposure of the common femoral artery (CFA), in the second group (41 patients) — by percutaneous puncture method under local anesthesia. Technical and clinical aspects of procedures were analyzed.Results. Technical success of endovascular repair was achieved in 100% cases in both groups. The duration of the operation in the group with percutaneous access was statically significantly shorter (120 (94-150) minutes vs 87(60-120) minutes, p=0,001). Also, the time spent by patients in the intensive care unit and the period of hospitalization (18 (14-22) hours versus 1 (0-3) hours, p=0,001; 5 (4-6) days versus 4 (3-5) days, p=0,03) was shorter. In the open access group 2 (4,2%) patients developed access-related complications - acute thrombosis of the common femoral artery and hematoma of the postoperative wound, which required additional surgical aid - thrombectomy from the CFA, the second patient had evacuation of the hematoma of the postoperative wound. Cite-related complications in the second group were not observed. No major complications including neurological deficits and hospital mortality were observed in both groups.Conclusions. Thoracic endovascular aortic repair (TEVAR) using percutaneous access under local anesthesia in stable patients has proven to be safe and effective. The operation time is significantly reduced and this approach in most cases eliminates the need for the patient to stay in the intensive care unit in the early postoperative period. Possibility of early mobilization of the patient appears with reducing of the duration of hospitalization.Keywords
This publication has 8 references indexed in Scilit:
- Percutaneous thoracic endovascular aortic repair is not contraindicated in obese patientsJournal of Vascular Surgery, 2014
- A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial)Journal of Vascular Surgery, 2014
- Predicting the learning curve and failures of total percutaneous endovascular aortic aneurysm repairJournal of Vascular Surgery, 2013
- The Kaiser Permanente Experience With Ultrasound-Guided Percutaneous Endovascular Abdominal Aortic Aneurysm RepairAnnals of Vascular Surgery, 2012
- Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology AssociationJournal of Vascular and Interventional Radiology, 2010
- Percutaneous Access for Endovascular Aneurysm Repair: A Systematic ReviewEuropean Journal of Vascular and Endovascular Surgery, 2010
- Local anesthesia for endovascular abdominal aortic aneurysm repairJournal of Vascular Surgery, 2005
- Endovascular suture versus cutdown for endovascular aneurysm repair: a prospective randomized pilot studyJournal of Vascular Surgery, 2003