The Kaiser Permanente Experience With Ultrasound-Guided Percutaneous Endovascular Abdominal Aortic Aneurysm Repair

Percutaneous Interventions in Aortic Disease

“…[35][36][37][38] There are many data to support this technique and the use of ultrasound guidance. The most compelling support for ultrasound guidance for PEVAR was published in a study by Sarmiento et al, 7 who found that the use of ultrasound guidance led to a 10-fold greater likelihood of success compared with PEVAR without ultrasound guidance (P=0.03). Conflicting data suggest that reversal of anticoagulation may 9,38,39 or may not 6,40 influence the technical success rate of percutaneous access closure.…”

“…45,46 More serious access site-related complications such as thrombosis, dissection, and distal embolization are exceedingly rare and represent a minority of all complications. 7,36 Analyses examining hospital administrative data found that PEVAR led to decreased operative time. 28,47 One meta-analysis averaged the operative time in 8 studies and found that PEVAR was significantly shorter by ≈30 minutes (106 versus 145 minutes).…”

“…34 With the use of the aforementioned techniques, the overall success rates of PEVAR were excellent, with most studies quoting an incidence of 90% to 96%. 7,31 One contemporary review of 22 articles that included 1087 patients revealed procedural success in 92% of patients. 43 A larger meta-analysis including 36 articles and 2257 patients (3606 access sites) revealed success in 92% of patients (94% per access site).…”

“…4 Although no risk-score modeling exists, the commonly used criteria in the selection of patients for a percutaneous approach include the following: at least a 1-cm segment of mid common femoral artery without anterior calcification, absence of severe scarring at the groin, no graft material at the access site, absence of a high common femoral bifurcation to preserve access length, and an arterial diameter that would allow insertion of the delivery device or sheath. [6][7][8] Computed tomographic angiographic evaluation is essential in helping to determine which patients are appropriate for a percutaneous approach. Previous use of a ProGlide, a single prior femoral artery cut down, and obesity are not considered contraindications for a percutaneous approach.…”

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

“…Ultrasound guided access is recommended to optimize arterial access when performing percutaneous EVAR (2,3). Next, considering the large arteriotomies which are required to deliver the large profile graft components,…”