Clinical efficacy and safety of the PRO-glide device as a sUture-mediated ClosurE in Thoracic EndoVascular Aortic Repair in patients with previous groin intervention (from the PRODUCE-TEVAR Trial)

Abstract

Background While the percutaneous approach is increasingly preferred, suture-mediated closure devices have been put into clinical practice to close the femoral artery during procedures requiring a large-sized introducer. However, scar in the groin is considered a contraindication or an exclusion criterion for percutaneous procedures. The aim of our study was to investigate the outcomes and safety of Pro-Glide device as suture-mediated closure device in patients who underwent thoracic endovascular aortic repair with percutaneous femoral access ≥22 F who had previous groin intervention. Methods A total of 73 patients who underwent endovascular repair with percutaneous femoral access were retrospectively included in the study. Previous groin intervention was defined as history of open surgical access or large sheath insertion (>18 F) to femoral artery because of endovascular or valvular intervention. Patients were divided into two groups as who had previous groin intervention PGI (+) and had not PGI (−). Results A total of 73 patients [60 male (82.2%)] were included in the study. Seventeen patients had PGI, and 56 did not. When groups were compared in terms of sheath sizes, a significantly higher sheath sizes were used in PGI (+) patients (24.5 ± 1.1 F vs. 23.8 ± 0.9 F, p = 0.005). The overall success rate in the femoral approach with pre-close technique was statistically insignificant between two groups (94.1% vs. 96.4%, p = 0.55). One patient in PGI (+) group and two patients in PGI (−) had technical failure for percutaneous femoral approach. One patient (5.9%) in PGI (+) group and one patient (1.8%) in PGI (−) group had femoral complications after the procedures; however, there was no significant difference between the groups in terms of complications (5.9% vs. 1.8%, p = 0.13). Conclusion Pro-Glide device may be a safe and less invasive method for femoral access in patients with PGI and might not be considered as a contraindication for patients with history of PGI.

Transcarotid versus transfemoral access for cerebrovascular intervention: protocol for a systematic review and meta-analysis

“…Transfemoral arterial access (TFA), introduced at the end of the 20th century for percutaneous coronary intervention, has become a popular and acceptable method of access for cerebrovascular angiography and intervention in clinical practice because it offers the advantages of being paid, technical simplicity, relatively painless and the ability to use larger catheters and equipment by clinicians 6. While TFA has been used with success for many years, it has some drawbacks including poor patient satisfaction, vascular complications, as well as some contraindications, such as peripheral vascular disease, femoral hernia and saddle embolism 7–12…”

“…6 While TFA has been used with success for many years, it has some drawbacks including poor patient satisfaction, vascular complications, as well as some contraindications, such as peripheral vascular disease, femoral hernia and saddle embolism. [7][8][9][10][11][12] Additionally, anatomic variants of the carotid artery or aortic arch prevent the…”