1Tania Guzman,1Isam Osman, 1Isam Osman, 1Zahra Alhaddad

1King Saud Medical City

Background(s):

Percutaneous access for endovascular abdominal (EVAR) and thoracic aortic interventions (TEVAR) may offer significant benefits to patients over open access. Safe arterial closure has been made possible by the increasing availability of novel closures devices. We report our experience with a preferential percutaneous approach and closure with a suture mediated closure device in a single centre.

Material(s) and Method(s):

Percutaneous access for endovascular abdominal (EVAR) and thoracic aortic interventions (TEVAR) may offer significant benefits to patients over open access. Safe arterial closure has been made possible by the increasing availability of novel closures devices. We report our experience with a preferential percutaneous approach and closure with a suture mediated closure device in a single centre.

Result(s):

Out of a total of 42 patients , 32 met the criteria and underwent percutaneous EVAR or TEVAR during the study period. 46% (15 out of 32 patients) were performed in an emergency setting. In total 41 femoral arteries were cannulated with a large bore introducer (average size 20 Fr, range 14 -25 Fr). Closure of the femoral artery with preloading technique was successful in 36 arteries(87%). A third device was required to achieve hemostasis in two further arteries achieving a primary success rate of 92% (38/41). In 8% (3/41) surgical intervention was required due to complications.In the first case an intimal dissection in a calcified artery caused arterial thrombosis.The remaining two bled :one with Marfanoid arteriopathy and in the second a resuscitative intra-aortic balloon without closure device preloading was used.

Conclusion(s):

Out of a total of 42 patients , 32 met the criteria and underwent percutaneous EVAR or TEVAR during the study period. 46% (15 out of 32 patients) were performed in an emergency setting. In total 41 femoral arteries were cannulated with a large bore introducer (average size 20 Fr, range 14 -25 Fr). Closure of the femoral artery with preloading technique was successful in 36 arteries(87%). A third device was required to achieve hemostasis in two further arteries achieving a primary success rate of 92% (38/41). In 8% (3/41) surgical intervention was required due to complications.In the first case an intimal dissection in a calcified artery caused arterial thrombosis.The remaining two bled :one with Marfanoid arteriopathy and in the second a resuscitative intra-aortic balloon without closure device preloading was used.