Percutaneous AAA repair:: Is it safe?

Purpose: To assess if percutaneous insertion of large-bore sheaths is safe during endovascular repair (EVR) for abdominal aortic aneurysms (AAA). Methods: Ninety-five AAA patients undergoing EVR had the endografts implanted percutaneously via 14-F to 20-F sheaths in a prospective nonrandomized study. Vascular sutures were applied bilaterally to the common femoral arteries using a vascular closure device; the sutures were tied after sheath withdrawal. Blood loss, operative time, and length of stay (LOS) were compared to 26 AAA patients undergoing EVR with bilateral femoral cut-downs before the percutaneous technique was available. Follow-up included duplex ultrasonography and clinical examination. Results: Bilateral percutaneous closure of the femoral arteries was successful in 78 (82 %) patients. Fifteen patients required arteriorrhaphy intraoperatively and 2 others within 24 hours. The failure rate was 20 %, 0 %, 3 %, and 7 % for the 20-F, 18-F, 16-F, and 14-F introducers, respectively. Blood loss was 400 mL (range 0-1800) in successful cases, 900 mL (range 0-3000) in failures (p<0.0001). One deep infection at the puncture site required thrombectomy and patchplasty; no other late complication occurred. There was no significant difference in operative time, blood loss, and LOS between patients treated with percutaneous EVR and those with primary femoral exposure. Conclusions: Percutaneous transfemoral EVR of AAA using large-bore introducer sheaths is safe. More than three quarters of the patients avoid femoral cutdown. Late complications are rare.