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Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms.

Abstract

INTRODUCTION

We sought to evaluate the safety and efficacy of totally percutaneous femoral access (TPFA) for fenestrated-branched endovascular aortic repair (F/B-EVAR) of pararenal-thoracoabdominal aortic aneurysms (PRAs/TAAAs).

METHODS

We reviewed all consecutive patients enrolled in single-center prospective non-randomized single-arm study to investigate F/B-EVAR for PRAs/TAAAs (2013-2017). Percutaneous approach was selected in all patients when anatomically feasible; otherwise, surgical femoral access (SFA), with or without construction of temporary prosthetic conduit, was selected. Primary outcomes were technical success, mortality, major adverse events (MAEs) and major vascular access complications.

RESULTS

A total of 231 patients were included in the study: TPFA was possible in 163 (70%) with technical success rate of 93%, while 68 (30%) required SFA. Patients with TPFA and SFA had similar mortality rate of 1%. The rate of MAEs for TPFA was 20% versus 38% for SFA (p = .07). The trend was mainly driven by reduced rates of estimated blood loss (EBL) ≥ 1L (6% vs 21%, p = .001) and acute myocardial infarction (2% vs 9%, p = .03). Similarly, TPFA carried a significantly lower rate of major vascular access complications as compared with SFA (6% vs 21%, p < .001; adjusted OR 3.4, 95% CI 1.3-8.9, p = .01).

CONCLUSION

A percutaneous-first approach for elective F/B-EVAR of PRAs/TAAAs is safe, feasible and effective when proper patient selection is provided. When the presence of hostile iliofemoral anatomy requires open-vessel exposure, higher rates of perioperative major bleeding, cardiac events and access complications may be expected.

LEVEL OF EVIDENCE

Level 3 (single-center prospective non-randomized single-arm study).

Authors+Show Affiliations

Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA. mario.doria88@outlook.com.Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA.Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA.Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA.Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA.Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31942649

Citation

D'Oria, Mario, et al. "Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms." Cardiovascular and Interventional Radiology, 2020.
D'Oria M, Oderich GS, Tenorio ER, et al. Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms. Cardiovasc Intervent Radiol. 2020.
D'Oria, M., Oderich, G. S., Tenorio, E. R., Kärkkäinen, J. M., Mendes, B. C., & DeMartino, R. R. (2020). Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms. Cardiovascular and Interventional Radiology, doi:10.1007/s00270-020-02414-8.
D'Oria M, et al. Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms. Cardiovasc Intervent Radiol. 2020 Jan 15; PubMed PMID: 31942649.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms. AU - D'Oria,Mario, AU - Oderich,Gustavo S, AU - Tenorio,Emanuel R, AU - Kärkkäinen,Jussi M, AU - Mendes,Bernardo C, AU - DeMartino,Randall R, Y1 - 2020/01/15/ PY - 2019/10/02/received PY - 2020/01/09/accepted PY - 2020/1/17/entrez KW - Fenestrated and branched endovascular aortic repair KW - Pararenal aortic aneurysms KW - Percutaneous access KW - Thoracoabdominal aortic aneurysms KW - Vascular closure device JF - Cardiovascular and interventional radiology JO - Cardiovasc Intervent Radiol N2 - INTRODUCTION: We sought to evaluate the safety and efficacy of totally percutaneous femoral access (TPFA) for fenestrated-branched endovascular aortic repair (F/B-EVAR) of pararenal-thoracoabdominal aortic aneurysms (PRAs/TAAAs). METHODS: We reviewed all consecutive patients enrolled in single-center prospective non-randomized single-arm study to investigate F/B-EVAR for PRAs/TAAAs (2013-2017). Percutaneous approach was selected in all patients when anatomically feasible; otherwise, surgical femoral access (SFA), with or without construction of temporary prosthetic conduit, was selected. Primary outcomes were technical success, mortality, major adverse events (MAEs) and major vascular access complications. RESULTS: A total of 231 patients were included in the study: TPFA was possible in 163 (70%) with technical success rate of 93%, while 68 (30%) required SFA. Patients with TPFA and SFA had similar mortality rate of 1%. The rate of MAEs for TPFA was 20% versus 38% for SFA (p = .07). The trend was mainly driven by reduced rates of estimated blood loss (EBL) ≥ 1L (6% vs 21%, p = .001) and acute myocardial infarction (2% vs 9%, p = .03). Similarly, TPFA carried a significantly lower rate of major vascular access complications as compared with SFA (6% vs 21%, p < .001; adjusted OR 3.4, 95% CI 1.3-8.9, p = .01). CONCLUSION: A percutaneous-first approach for elective F/B-EVAR of PRAs/TAAAs is safe, feasible and effective when proper patient selection is provided. When the presence of hostile iliofemoral anatomy requires open-vessel exposure, higher rates of perioperative major bleeding, cardiac events and access complications may be expected. LEVEL OF EVIDENCE: Level 3 (single-center prospective non-randomized single-arm study). SN - 1432-086X UR - https://www.unboundmedicine.com/medline/citation/31942649/Safety_and_Efficacy_of_Totally_Percutaneous_Femoral_Access_for_Fenestrated-Branched_Endovascular_Aortic_Repair_of_Pararenal-Thoracoabdominal_Aortic_Aneurysms L2 - https://dx.doi.org/10.1007/s00270-020-02414-8 DB - PRIME DP - Unbound Medicine ER -