Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair

Abstract

PEVAR using VCDs can be performed with high technical success in patients with <50% anterior wall calcification, regardless of the size of the access sheath or the patient's body mass index. Femoral artery calcification, however, is a major determinant of failure.

Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts

“…21 Our technical success rate of 95% compares favorably with prior reports (Table III). [1][2][3][4][5][6][7][8][9][10][11][12]14,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Despite the use of different devices and some variations on techniques, three meta-analysis have shown >90% technical success with a low incidence of complications. 13,37,38 With respect to reports dealing with thoracic or fenestrated and branched endografts, there are limited data.…”

“…The technique has been previously described elsewhere. 1 Percutaneous access was established under ultrasound guidance with a 0.018-inch micropuncture needle entrance in the anterior common femoral artery wall 1 to 2 cm proximal to the bifurcation ( Supplementary Fig 2, online only). Punctures distal to the femoral bifurcation or in calcified areas were avoided.…”

“…The potential advantages of a percutaneous EVAR (PEVAR) include a lower risk of wound-related complications (eg, seroma, infection, nerve injury) and a reduction in operative time, blood loss, and hospital stay. [1][2][3][4] Disadvantages are the added cost of PVCDs and the potential risk of inadequate arterial closure or inadvertent injury resulting in excessive hemorrhage, hematoma, pseudoaneurysm, or arterial occlusion. Perioperative hypotension from uncontrolled hemorrhage is also a feared complication in patients with complex aortic disease because of the risk of spinal cord injury.…”

Percutaneous access planning, techniques and considerations for endovascular aortic repair (EVAR)

“…Reported complication rates with CFA access have ranged from 1.5% to 17%, especially with the use of larger sheaths. Access site complications of the CFA include hematoma, pseudoaneurysm, bleeding, access artery occlusion, distal embolization, infections, and venous thrombosis.9 Anterior femoral artery calcification correlates with a higher likelihood (83%) of failure due to inadequate suture mediated closure (15). Other complications include retroperitoneal bleeding, which is more commonly seen with a high arteriotomy, and post-procedure neuralgic pain.…”

“…Radial access site complications include hematoma, pseudoaneurysm, bleeding, access artery occlusion (4%), distal embolization. While stroke is a major theoretical concern for radial access, no significant differences in stroke rates were seen between radial and femoral access for coronary intervention (15,16).…”