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La radiologia medica

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01-11-2014 | Vascular and Interventional Radiology

A single-centre experience of 200 consecutive unselected patients in percutaneous EVAR

Authors: Sergio Petronelli, Maria Teresa Zurlo, Silvia Giambersio, Lucia Danieli, Mariaelena Occhipinti

Published in: La radiologia medica | Issue 11/2014

Abstract

Purpose

This study evaluated the feasibility and safety of percutaneous endovascular aneurysm repair (P-EVAR) in an “unselected” population of patients using Prostar XL closure device, comparing our results with the literature data reported for open EVAR (O-EVAR) and P-EVAR in selected populations.

Materials and methods

We prospectively enrolled 200 patients with abdominal aortic aneurysms to be treated with the P-EVAR procedure, without any selection criteria. Four hundred percutaneous femoral accesses using the Prostar XL closure device were performed. The early follow-up protocol consisted of a Doppler ultrasound (US) examination. Later evaluations were performed with US and computed tomography.

Results

Technical success was achieved in all percutaneous accesses (100 %). Ten early complications related to access site were recorded (10/400; 2.5 %): four pseudoaneurysms and six cases of lower limb ischaemia. Five of ten complications occurred in patients presenting calcification of the common femoral arteries, whereas 4/10 were in patients with “complex” groin anatomy. Eight of ten complications occurred at the access site of the main body of the prosthesis using a sheath size >20 Fr.

Conclusions

Percutaneous endovascular aneurysm repair in “unselected” patients is safe and efficient, with a very low risk of access-related complications, comparable to P-EVAR in selected populations and to the best O-EVAR series.

Malkawi AH, Hinchliffe RJ, Holt PJ et al (2010) Percutaneous access for endovascular aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg 39:676–682PubMedCrossRef

Eisenack M, Umscheid T, Tessarek J et al (2009) Percutaneous endovascular aortic aneurysm repair: a prospective evaluation of safety, efficiency, and risk factors. J Endovasc Ther 16:708–713PubMedCrossRef

Howell M, Doughtery K, Strickman N et al (2002) Percutaneous repair of abdominal aortic aneurysms using the AneuRx stent graft and the percutaneous vascular surgery device. Catheter Cardiovasc Interv 55:281–287PubMedCrossRef

Starnes BW, Anderson CA, Ronsivalle JA et al (2006) Totally percutaneous aortic aneurysm repair: experience and prudence. J Vasc Surg 43:270–276PubMedCrossRef

Singh N, Adams E, Neville R et al (2005) Percutaneous endovascular AAA repair. Endovascular Today, pp 39–44

Can A, Torsello G, Umscheid T (2008) The arterial approaches for endovascular aortic grafting. In: Jacobs M, Branchereau A (eds) Endovascular aortic repair: the state of the art. Oxford Blackwell Publishing, Oxford, pp 57–61

Murray D, Ghosh J, Khwaja N et al (2006) Access for endovascular aneurysm repair. J Endovasc Ther 13:754–761PubMedCrossRef

Torsello GB, Kasprzak B, Klenk E et al (2003) Endovascular suture versus cutdown for endovascular aneurysm repair: a prospective randomized pilot study. J Vasc Surg 38:78–82PubMedCrossRef

Teh LG, Sieunarine K, van Schie G et al (2001) Use of the percutaneous vascular surgery device for closure of femoral access sites during endovascular aneurysm repair: lessons from our experience. Eur J Vasc Endovasc Surg 22:418–423PubMedCrossRef

10.

Traul DK, Clair GD, Gray B et al (2000) Percutaneous endovascular repair of infrarenal abdominal aortic aneurysms: a feasibility study. J Vasc Surg 32:770–776PubMedCrossRef

11.

Torsello G, Tessarek J, Kasprzak B et al (2002) Treatment of aortic aneurysm with a complete percutaneous technique. An update after treatment of 80 patients. Dtsch Med Wochenschr 127:1453–1457PubMedCrossRef

12.

Lee WA, Brown MP, Nelson PR et al (2007) Total percutaneous access for endovascular aortic aneurysm repair (‘‘Preclose’’ technique). J Vasc Surg 45:1095–1101PubMedCrossRef

13.

Lee WA, Brown MP, Nelson PR et al (2008) Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the Preclose technique. J Vasc Surg 47:919–923PubMedCrossRef

14.

Oğuzkurt L, Gürel K, Eker E et al (2012) Ultrasound-guided puncture of the femoral artery for total percutaneous aortic aneurysm repair. Diagn Interv Radiol 18:92–95PubMed

15.

Nehler MR, Lawrence WA, Whitehill TA et al (2001) Iatrogenic vascular injuries from percutaneous vascular suturing devices. J Vasc Surg 33:943–947PubMedCrossRef

16.

Cuypers PW, Laheij R, Buth J (2000) Which factors increase the risk of conversion to open surgery following endovascular abdominal aortic aneurysm repair? Eur J Vasc Endovasc Surg 20:183–189PubMedCrossRef

17.

Watelet J, Gallot JC, Thomas P et al (2006) Percutaneous repair of aortic aneurysms: a prospective study of suture-mediated closure devices. Eur J Vasc Endovasc Surg 32:261–265PubMedCrossRef

18.

Smith ST, Timaran CH, Valentine RJ et al (2009) Percutaneous access for endovascular abdominal aortic aneurysm repair: can selection criteria be expanded? Ann Vasc Surg 23:621–626PubMedCrossRef

19.

Arthurs ZM, Starnes BW, Sohn VY et al (2008) Ultrasound-guided access improves rate of access-related complications for totally percutaneous aortic aneurysm repair. Ann Vasc Surg 22:736–741PubMedCrossRef

20.

Rachel ES, Bergamini TM, Kinney EV et al (2002) Percutaneous endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 16:43–49PubMedCrossRef

21.

Dosluoglu HH, Cherr GS, Harris LM et al (2007) Total percutaneous endovascular repair of abdominal aortic aneurysms using Perclose Proglide closure devices. J Endovasc Ther 14:184–188PubMedCrossRef

22.

Borner G, Ivancev K, Sonesson B et al (2004) Percutaneous AAA repair: is it safe? J Endovasc Ther 11:621–626PubMedCrossRef

23.

Perdikides TP, Georgiadis GS, Avgerinos ED et al (2012) Percutaneous endovascular treatment of aortic aneurysms: clinical evaluation and literature results. Minim Invasive Ther Allied Technol 21:342–350PubMedCrossRef

24.

Georgiadis GS, Antoniou GA, Papaioakim M et al (2011) A meta-analysis of outcome after percutaneous endovascular aortic aneurysm repair using different size sheaths or endograft delivery systems. J Endovasc Ther 18:445–459PubMedCrossRef

25.

Stelter W, Umscheid T, Ziegler P (1997) Three year experience with modular stent-graft devices for endovascular AAA treatment. J Endovasc Surg 4:362–369PubMedCrossRef

26.

Brewster DC, Geller SC, Kaufman JA et al (1998) Initial experience with endovascular aneurysm repair: comparison of early results with outcome of conventional open repair. J Vasc Surg 27:992–1003PubMedCrossRef

27.

Morasch MD, Kibbe MR, Evans ME et al (2004) Percutaneous repair of abdominal aortic aneurysm. J Vasc Surg 40:12–16PubMedCrossRef

28.

Faries PL, Brener BJ, Connelly TL et al (2002) A multicentre experience with the Talent endovascular graft for the treatment of abdominal aortic aneurysms. J Vasc Surg 35:1123–1128PubMedCrossRef

29.

Chuter TAM, Lukaszewicz GC, Kerlan RB et al (2000) Is percutaneous endovascular AAA repair feasible? J Endovasc Ther 7:1–6

30.

Dalainas I, Nano G, Casana R et al (2004) Mid-term results after endovascular repair of abdominal aortic aneurysms: a four-year experience. Eur J Vasc Endovasc Surg 27:319–323PubMedCrossRef

31.

Jean-Baptiste E, Hassen-Khodja R, Haudebourg P et al (2008) Percutaneous closure devices for endovascular repair of infrarenal abdominal aortic aneurysms: a prospective, non-randomized comparative study. Eur J Vasc Endovasc Surg 35:422–428PubMedCrossRef

32.

McDonell CO, Forlee MV, Dowdall JF et al (2008) Percutaneous endovascular abdominal aortic aneurysm repair leads to a reduction in wound complications. Ir J Med Sci 177:49–52CrossRef

33.

Haulon S, HassenKhodja R, Proudfoot CW et al (2011) A systematic literature review of the efficacy and safety of the Prostar XL device for the closure of large femoral arterial access sites in patients undergoing percutaneous endovascular aortic procedures. Eur J Vasc Endovasc Surg 41:201–213PubMedCrossRef

Title: A single-centre experience of 200 consecutive unselected patients in percutaneous EVAR
Authors: Sergio Petronelli
Maria Teresa Zurlo
Silvia Giambersio
Lucia Danieli
Mariaelena Occhipinti
Publication date: 01-11-2014
Publisher: Springer Milan
Published in: La radiologia medica / Issue 11/2014
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-014-0399-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A single-centre experience of 200 consecutive unselected patients in percutaneous EVAR

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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