Thoracic Endovascular Aortic Repair Using the Percutaneous Technique or Open Exposure; A Comparison of Early Outcomes
Marshall T. Bell, Lisa S. Foley, Daine T. Bennett, Rajan Gupta, Omid Jazaeri, Paul J. Rochon, T Brett Reece.
University of Colorado, Aurora, CO, USA.
OBJECTIVE: TEVAR has become the primary mode of treatment for TAA over the last 10 years. Traditionally, this has required open exposure of the common femoral artery for sheath delivery. Devices for percutaneous closure have been applied EVAR, however due to larger sheath sizes this technology has lagged in TEVAR. We hypothesized that percutaneous techniques could be applied to TEVAR and that this minimally invasive technique will improve early outcomes following intervention.
METHODS: A retrospective chart review of fifty-five patients undergoing TEVAR from February 2006 to December 2012 was conducted. Twenty-six patients underwent attempted total percutaneous TEVAR using preclosure technique were compared to twenty-nine patients that had received TEVAR with standard surgical cut down. All patients in percutaneous group received preoperative CTA or intraoperative pelvic angiogram to determine appropriateness of percutaneous closure. Outcomes measured included successful percutaneous closure, technical success rate, early complication rates, and hospital course.
RESULTS: Following TEVAR there was no difference in technical success. Of the total percutaneous group, 11.5% required conversion to surgical cut down for closure. Reason for conversion included need for hemostasis 7.7% and vessel occlusion 3.8%. There was no difference in ICU or hospital stay. Patients that had received standard surgical cut down had a significantly higher incidence of postoperative hematoma and wound infections (p<0.02) when compared to the total percutaneous approach.
CONCLUSIONS: Total percutaneous approach for TEVAR can be applied easily and with minimal risk to the patient when used in appropriate patients. Additionally these approaches can minimize the risk of post-operative wound complications. With some consideration, percutaneous closure of large sheath access for TEVAR is safe and effective.
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