Comparison between PeRcutanEous and surgical femoral aCcess for endovascuLar aOrtic repair in patientS with typE III aortic Dissection (PRECLOSE Trial)

Abstract

Objectives Aortic dissections are cardiovascular events with high mortality and morbidity rates. Management might be either with medical or interventional approach. Recently, thoracic endovascular intervention (TEVAR) becomes the first treatment of choice because of its better results and lower rates of complications in patients with type III aortic dissections. The intervention might be performed via femoral artery either with percutaneous or with surgical approach. Because of large sheath insertion to femoral artery, Pre-close technique is described in literature. The aim of this study was to investigate and compare the outcomes and safety of ‘Pre-close technique’ to surgical approach in patients with type III aortic dissections who underwent TEVAR with femoral access ≥22 F. Methods A total of 96 patients whom had type III aortic dissection and was performed TEVAR were retrospectively included in the study. Fifty-six patients had TEVAR with percutaneous approach and these patients are named as P-TEVAR group, and 40 patients had TEVAR with surgical approach and these patients are named as S-TEVAR group. Pre- and post-procedural data with complications and procedural data during TEVAR were evaluated for both groups and compared in between. Results The main finding was that there was no significant difference between S-TEVAR and P-TEVAR groups in terms of complications and technical success. Operating room time was significantly decreased in P-TEVAR group ( P < 0.001). Overall success rate for femoral approach in patients with Pre-close technique was 94.6% and was 100% for surgical approach. P-TEVAR group had post-operative complications in three patients and S-TEVAR group had in four patients. Conclusions Total percutaneous approach with Pre-close technique using Pro-Glide device is a safe and feasible method of femoral access in patients with type III aortic dissections.

A Novel Plug-Based Vascular Closure Device for Percutaneous Femoral Artery Closure in Patients Undergoing Minimally-Invasive Valve Surgery

“…For the ProGlide device only small series of application in MIS valve surgery are documented ( 18 ). However, it is known from a broad adaption in endovascular aortic procedures that device success ranges between 92 and 95% and complication rates are low ( 19 , 20 ).…”