Hospitals that complete fewer than five OARs or eight EVARs annually have significantly greater mortality compared with their counterparts. Improved implementation of best practices, more detailed informed consent to include hospital mortality data, and better regional access to health care may improve survival after elective AAA repair.

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Economic analysis, level III.

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The Perclose ProGlide (Abbott Vascular, Santa Clara, Calif) is indicated for the closure of 5F to 21 F femoral artery access sites. We describe an adjunctive technique for the use of the ProGlide vascular closure device to improve hemostasis. After routine use of the device, a hollow tube (cut from the injection port of an introducer sheath) is placed over the free tails of suture. These tubes are secured in place by a hemostat that grasps the free suture tails, creating a Rummel-style tourniquet that compresses the arteriotomy, improving hemostasis. The tubes doubly serve as a conduit for the administration of prothrombotic agents directly in the event that hemostasis is not adequately achieved.