Burkhart Zipfel, Semih Buz, Robert Hammerschmidt, Roland Hetzer.
Deutsches Herzzentrum Berlin, Berlin, Germany.
OBJECTIVE:
To evaluate whether percutaneous access reduces local complications of thoracic endografting related to surgical access to the femoral artery.
METHODS:
In 23 of 302 thoracic aortic endograft procedures percutaneous access to the femoral artery was used. Patients were selected for percutaneous procedure, when in the CT-scan the external iliac artery was >8 mm in diameter and no calcification of the anterior wall of the common femoral artery was noted. Two U-sutures were placed in the femoral artery using a Prostar® percutaneous suture device, before the delivery sheaths of the endografts with outer diameters of 23 to 26 F were advanced into the artery. The U-sutures were tied at the end of the procedure. Indications for stent-grafting were type-B dissection in 11, suture aneurysm in 3, true aneurysm in 6, penetrating atherosclerotic ulcer in 2 and posttraumatic aneurysm in 1 case. All procedures were performed in the operation room.
RESULTS:
All stent-grafts were successfully deployed through the percutaneous approach. In five cases the femoral artery had to be exposed because of incomplete sealing of the percutaneous sutures. These conversions occurred in the first half of the series. The table surveys femoral access site complications. The data compared favorably with those of 249 stent-graft procedures performed through conventional exposure of the femoral artery. Reoperations through the same femoral artery are included in both groups.
CONCLUSIONS:
The technique described is safe even in thoracic endografting with bigger delivery systems than in abdominal endografts. Proper selection of the cases is mandatory and there is a significant learning curve. The percutaneous technique should only be applied if immediate surgery is possible in case of failure. The technique seems to be able to reduce local lymph and nerve complications and to further improve patient comfort of the endograft procedure.Femoral access site complications Percutaneous
n = 23Cut down
n = 249Conversion to surgical repair 5 (22 %) n. a. Minor hematoma 4 (17 %) 4 (1.6 %) False aneurysm, surgical repair 1 (4 %) 1 (0.4 %) Lymph fistula or lymph cyst 0 11 (4.4 %) Surgery for lymph complications 0 5 (1.8 %) Femoral nerve impairment 0 3 (1.2 %) Groin infection 0 1 (0.4. %)
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