Comparison Of Different Femoral Closure Techniques In Minimally İnvasive Cardiovascular Interventions
Mehmet Çakıcı, Mustafa Bahadır İnan, Alper Özgür, Evren Özçınar, Çağdaş Baran, Levent Yazıcıoğlu, Sadık Eryılmaz, Bülent Kaya, Ahmet Rüçhan Akar.
Ankara University, Ankara, Turkey.
OBJECTIVE: Femoral artery (FA) is the main access route in patients who undergo minimally invasive cardiac surgery (MICS) and endovascular aortic surgery. Different techniques have been reported for the exploration and repair of FA after surgical procedure. In our clinic, a modified approach alternative to the conventional technique (group CT), was the method of choice since May 2013; which specifies a shorter groin incision and diamond shaped haemostatic purse sutures for arteriotomy closure without the requirement of cross-clamping (group PT) . We aimed to evaluate early outcomes and the complication profiles of the two techniques for femoral access.
METHODS: In our clinic, between May 2011 and December 2015, 476 FA cannulations were performed on 325 patients who underwent MICS (n=105; mean age:54.4±18.8; F/M:70/35), EVAR (n=151; mean age:72.5±9.35; F/M:60/91), TEVAR (n=45; mean age:64.9±15.6; F/M:12/33) and TAVI (n=24; mean age:81.5±5.7; F/M:12/12). A total number of 278 FAs were exposed via mini incision and were repaired with the PT. We compared the duration of femoral closure (FC), wound infection, vascular complications including bleeding-hematoma, thromboembolic and ischemic events, pseudoaneurysm, seroma, surgical reintervention rates, delayed hospital stay for groin complications and existence of postoperative local luminal narrowing (LLN) at intervention site over 25% for both groups.
RESULTS: FC time, bleeding-hematoma frequent and prolonged hospital stay for groin complications were significantly lower in the group using the PT. There were no differences between groups in terms of ischemic events, wound infection rates, development of pseudoaneurysm and seroma, surgical reintervention rates and LLN of FA over %25 at 6 month Dupplex evaluation.
CONCLUSIONS: The comparison of the two approaches revealed the advantages of the PT in terms of bleeding-hematoma and shortening in FC time and the lenght of hospital stay. We suggest performing a smaller skin incision for FA access and utilizing purse sutures, which allows completing the procedure without cross-clamping, thus, providing a favorable approach and excellent comfort for the surgeon, especially in the case of calcific vessels which are prone to complications.
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