Purpose: To describe a percutaneous “purse-string-like” technique to downsize the femoral access sheath achieving early pelvis and limb reperfusion during complex endovascular aortic repair, while maintaining a sheath in place. Materials and Methods: After ultrasound-guided femoral catheterization, two Perclose ProGlide vascular closure devices (VCD) are employed with the pre-close technique. When the deployment of aortic components is complete, the large delivery sheath is exchanged for a smaller non-occlusive one (≤ 10 F) and the rail suture of both VCDs is pulled to achieve hemostasis. At the end of the procedure, the access is closed according to standard technique. Results: Fifty-eight femoral accesses were downsized achieving hemostasis with a completion percutaneous closure success of 95% (55/58). The median ischemic time to the limb was 66 min (IQR 31–131) for the main access and 65 min (IQR 30–100) for the contralateral one. When compared to a 1:2 propensity score-matched cohort who did not undergo access downsizing, no differences in closure success were recorded (95% vs. 89%, p = 0.19). However, hemostasis required more frequently an additional ProGlide in the downsizing group (26 cases, 45% vs. 17 cases, 15%; p <.001). Conclusion: Percutaneous purse-string-like sheath downsizing to restore perfusion to limbs and pelvis during complex endovascular aortic repair is feasible with high closure success rates, although a third ProGlide is more frequently needed to achieve hemostasis. The impact of this practice on SCI rates requires further evaluation in larger series as part of a multimodal approach for spinal cord protection.

Safety and Feasibility of Percutaneous Purse-String-Like Downsizing for Femoral Access During Complex Endovascular Aortic Repair

Melloni A.;Melissano G.;Chiesa R.;Bertoglio L.
2020-01-01

Abstract

Purpose: To describe a percutaneous “purse-string-like” technique to downsize the femoral access sheath achieving early pelvis and limb reperfusion during complex endovascular aortic repair, while maintaining a sheath in place. Materials and Methods: After ultrasound-guided femoral catheterization, two Perclose ProGlide vascular closure devices (VCD) are employed with the pre-close technique. When the deployment of aortic components is complete, the large delivery sheath is exchanged for a smaller non-occlusive one (≤ 10 F) and the rail suture of both VCDs is pulled to achieve hemostasis. At the end of the procedure, the access is closed according to standard technique. Results: Fifty-eight femoral accesses were downsized achieving hemostasis with a completion percutaneous closure success of 95% (55/58). The median ischemic time to the limb was 66 min (IQR 31–131) for the main access and 65 min (IQR 30–100) for the contralateral one. When compared to a 1:2 propensity score-matched cohort who did not undergo access downsizing, no differences in closure success were recorded (95% vs. 89%, p = 0.19). However, hemostasis required more frequently an additional ProGlide in the downsizing group (26 cases, 45% vs. 17 cases, 15%; p <.001). Conclusion: Percutaneous purse-string-like sheath downsizing to restore perfusion to limbs and pelvis during complex endovascular aortic repair is feasible with high closure success rates, although a third ProGlide is more frequently needed to achieve hemostasis. The impact of this practice on SCI rates requires further evaluation in larger series as part of a multimodal approach for spinal cord protection.
2020
Access
Aneurysm
Downsizing
EVAR
Femoral
FEVAR
Ischemia
Limb
Percutaneous
Spinal cord ischemia
Thoracoabdominal
Aged
Aorta
Aortic Aneurysm
Cohort Studies
Endovascular Procedures
Feasibility Studies
Female
Femoral Artery
Humans
Male
Retrospective Studies
Treatment Outcome
Ultrasonography, Interventional
Vascular Closure Devices
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/107995
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 10
  • ???jsp.display-item.citation.isi??? 10
social impact