Effectiveness of fascial closure technique following percutaneous endovascular aneurysm repair

Abstract

Introduction Percutaneous access and closure is commonly performed for patients undergoing endovascular aneurysm repair (EVAR). It has proven to be a safe and successful method of closure associated with fewer complications when compared with the traditional open technique. Fascial closure is an alternative technique that can be used for closure reducing the risks associated with the open technique. The aim of this study was to assess the safety and durability of fascial closure for failed percutaneous closure device following EVAR. Materials and methods Over a 12-month period, 49 patients who had undergone EVAR were identified via our EVAR register. Retrospective analysis of the clinical records was undertaken. We identified all the patients who had fascial closure of the groins following a failed percutaneous closure device. Patients had a computed tomography angiogram one month postoperatively, with duplex imaging and clinic follow-up three months later. Results Fascial closure was performed in 14 groins. It failed in three groins and these patients had traditional open repair. Fascial closure was successful in 11 groins (7 patients). Of these seven patients, one was female (6%). The mean age was 80 years (range 68–92 years). Two patients died and one was lost to follow-up. One pseudoaneurysms were seen on computed tomography angiogram, which was managed conservatively and had resolved on follow-up imaging. Conclusions Fascial closure is a very good alternative to open repair after failure of the closure device.

Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR—A Randomized Trial

“…The choice of arterial closure technique used should be a matter for the individual centers and operating surgeons to choose. The authors believe that there is still a role for fascia closure and cut-down technique despite the introduction of PCD into clinical practice since these open techniques remain as common rescue techniques when PCDs fail to achieve adequate hemostasis [ 21 ]. The success rate of PCD and fascia closure was in a systematic review of both RCTs and observational studies 63–100% for PCD and 87–99% for fascia closure.…”

A Single Center Study of ProGlide Used for Closure of Large-Bore Puncture Holes After EVAR for AAA

“…We have used the Fascia Suture Technique in addition to traditional surgical cutdown as a “bail-out” procedure when the percutaneous options have failed. 10,14,23,24 An advantage with the Fascia Suture Technique, in comparison to surgical cutdown, is that it is less invasive. It has also shown complication rates 24,25 equivalent to the SMCD device Prostar (Abbott Vascular, IL, USA).…”

“…10,14,23,24 An advantage with the Fascia Suture Technique, in comparison to surgical cutdown, is that it is less invasive. It has also shown complication rates 24,25 equivalent to the SMCD device Prostar (Abbott Vascular, IL, USA). 23…”