Comparison of percutaneous access and open femoral cutdown in elective endovascular aortic repair of abdominal aortic aneurysms

Background: The aim of this study was to compare postoperative outcomes of percutaneous access and femoral cutdown methods for elective bifurcated endovascular abdominal aortic aneurysm repair. Methods: Between November 2013 and September 2020, a total of 152 patient (135 males, 17 females; mean age: 70.6 +/- 6, range, 57 to 87 years) who underwent endovascular repair due to infrarenal abdominal aortic aneurysm were retrospectively analyzed. According to femoral access type, the patients were grouped into two groups as the total percutaneous femoral access and open cutdown femoral access endovascular repair. Intra-and postoperative data were compared, including operative time, amount of contrast media, bleeding requiring transfusion, return to the operating room, access vessel complications, wound complications, and overall length of hospital stay. Results: Eighty-seven (57.2%) femoral cutdown access repair and 65 (42.8%) percutaneous femoral access repair cases were evaluated in the study. The two groups were comparable in terms of demographic and clinical characteristics (p>0.05), except for chronic obstructive pulmonary disease which was more frequent in the percutaneous access group (p=0.014). After adjustment, age, diabetes mellitus, chronic obstructive pulmonary disease, and obesity were not predictive of percutaneous access failure. Percutaneous femoral access was observed as the only preventing factor for wound infection (odds ratio=0.166, 95% confidence interval: 0.036-0.756; p=0.021). Conclusion: Although femoral access preference does not affect mortality and re-intervention rates, percutaneous endovascular repair reduces operation time, hospital stay, and wound site complications compared to femoral artery exposures.