Predilation technique with balloon angioplasty to facilitate percutaneous groin access of large size sheath through scar tissue

Pecoraro, Felice; Krishnaswamy, Mrudula; Steuer, Johnny; Puippe, Gilbert; Mangialardi, Nicola; Pfammatter, Thomas; Rančić, Zoran; Veith, Frank J.; Cayne, Neal S.; Lachat, Mario

doi:10.1177/1708538116688786

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…13,14 Finally, the ultralow profile also facilitates percutaneous use in redo groins. 15 This was confirmed in this series, in which there was no femoral access complication during or after Horizon introduction.…”

Section: Journal Of Vascular Surgerysupporting

confidence: 72%

Early outcomes with a single-sided access endovascular stent

Hofmann

Pecoraro

Planer

et al. 2018

Journal of Vascular Surgery

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Section: Journal Of Vascular Surgerysupporting

confidence: 72%

Early outcomes with a single-sided access endovascular stent

Hofmann

Pecoraro

Planer

et al. 2018

Journal of Vascular Surgery

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“…11,12 All percutaneous accesses were performed with the preclosure technique (Proglide, Abbott Vascular, Redwood City, CA, USA), 13 under DUS imaging. Axillary percutaneous access was performed using the micropuncture technique to reduce the risk of nerve or plexus damage.…”

Section: Techniquementioning

confidence: 99%

Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

Pecoraro

Lachat

Cayne

et al. 2017

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThe use of chimney and periscope grafts for the treatment of aneurysms involving the supra-aortic branches is reported with mid-term follow-up. This tool uses off the shelf devices and it can be employed in the emergency setting. This single centre experience reports the use of self expandable covered stents for parallel graft construction with particular attention to a standardised technique. The limited experience and follow-up available allow the use of this technique in high risk patients unfit for conventional surgery.Purpose: Report mid-term outcomes of thoracic endovascular aneurysm repair (TEVAR) with chimney and periscope grafts (CPG) in supra-aortic branches (SAB). Methods: Retrospective analysis, from October 2009 to May 2014, of patients with aneurysms requiring TEVAR with zone 0/1/2 proximal landing in association with at least one CPG in the SAB. All patients were considered at high risk for conventional surgery. Peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic transverse diameter (TD) and its post-operative evolution, endoleak, survival, freedom from cardiovascular re-interventions, and CPG freedom from occlusion during the follow-up were analysed. Results: Forty-one patients (28.05% EuroScore II) with thoraco-abdominal aortic aneurysm (17%), arch aneurysm (39%), descending aneurysm (34%), and aneurysm extending from the arch to the visceral aorta (10%) were included. Fifteen (37%) patients were treated non-electively. Fifty-nine SABs were treated with the CPG technique: one, two, three, and four CPG were employed in 71%, 19%, 5%, and 5% of patients, respectively. The proximal landing was in zone 0 in 49% of patients, zone 1 in 17%, and zone 2 in 34%. Technical success was 95%. Peri-operative complications and neurological events were registered in six (14.6%) patients and there were 5 deaths (12%). At a median follow-up of 21.2 (mean 22, SD 18; range 0e65) months, type I/III endoleaks were registered in three (7%) cases and re-intervention in six (15%) patients. A significant aneurysm sac shrinkage (p<.001) was reported at mean follow-up and no significant aneurysm sac increase (>5 mm). The estimated 2 year survival, freedom from re-intervention, freedom from endoleak, and freedom from branch occlusion were 75%, 77%, 86%, and 96%, respectively. Conclusion: The chimney and periscope grafts technique was shown to be safe in aortic aneurysm disease involving the supra aortic branches, even in an emergency setting using off the shelf devices. Mid-term follow-up results in this high risk population are good, but longer follow-up is mandatory before this technique is used in intermediate-risk patients. Ó

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“…Unfortunately, the authors did not provide any information about either postinterventional complications or the need for surgical revision. 21 In our univariate analysis, previously reported risk factors for failure of percutaneous femoral access, such as female gender, diabetes mellitus, and previous stroke, were not associated with percutaneous access failure. However, increasing sheath size was close to be a significant risk factor for both conversion to open approach and postinterventional access complications.…”

Section: Discussionmentioning

confidence: 51%

Safety of Percutaneous Femoral Access for Endovascular Aortic Aneurysm Repair Through Previously Surgically Exposed or Repaired Femoral Arteries

et al. 2022

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Objective: Percutaneous femoral artery access is being increasingly used in endovascular aortic repair (EVAR). The technique can be challenging in patients with previously surgically exposed or repaired femoral arteries because of excessive scar tissue. However, a successful percutaneous approach may cause less morbidity than a “re-do” open femoral approach. The aim of this study was to assess the impact of prior open surgical femoral exposure on technical success and clinical outcomes of percutaneous approach. Methods: This study retrospectively reviewed the clinical data of patients who underwent percutaneous EVAR between 2010 and 2020 at 2 major aortic centers. Patients were divided into 2 groups (with or without prior open surgical femoral access) for analysis of clinical outcomes. Only punctures with sheaths ≥12Fr were included for analysis. The access and (pre)closure techniques were similar in both institutions. Primary end points were intraoperative technical success, access-related revision, and access complications. A multivariate analysis was performed to identify determinants of conversion to open approach and femoral access complications in intact and re-do groins. Results: A total of 632 patients underwent percutaneous (complex) EVAR: 98 had prior open surgical femoral access and 534 patients underwent de novo femoral percutaneous access. A total of 1099 femoral artery punctures were performed: 149 in re-do and 950 in intact groins. The extent of endovascular repair included 159 infrarenal, 82 thoracic, 368 fenestrated/branched, and 23 iliac branch devices. No significant differences were seen in technical success (re-do 93.3% vs intact 95.3%, p=0.311), access-related surgical revision (0.7% vs 0.6%, p=0.950), and access complications (2.7% vs 4.0%, p=0.443). For the whole group, significant predictors for access complications in multivariate analyses were main access site (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.07%–5.35%; p=0.033) and increase of the procedure time per hour (OR 1.65; 95% CI 1.34%–2.04%; p<0.001), while increase in sheath-vessel ratio had a protective effect (OR 0.33; 95% CI 0.127%–0.85%; p=0.021). Surgical conversion was predicted by main access site (OR 2.32; 95% CI 1.28%–4.19%; p=0.007) and calcification of 50% to 75% of the circumference of the access vessel (OR 3.29; 95% CI 1.38%–7.86%; p=0.005). Conclusion: Within our population prior open surgical femoral artery exposure or repair had no negative impact on the technical success and clinical outcomes of percutaneous (complex) endovascular aortic aneurysm repair.

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Predilation technique with balloon angioplasty to facilitate percutaneous groin access of large size sheath through scar tissue

Cited by 9 publications

References 18 publications

Early outcomes with a single-sided access endovascular stent

Early outcomes with a single-sided access endovascular stent

Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

Safety of Percutaneous Femoral Access for Endovascular Aortic Aneurysm Repair Through Previously Surgically Exposed or Repaired Femoral Arteries

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