Fascial Suture Technique Vs. Open Femoral Access for Thoracic Endovascular Aortic Repair

Purpose: To describe a technique to catheterize antegrade branches of a branched thoracoabdominal endograft from a femoral access with the help of standard sheaths and a vascular suture. Technique: The technique is demonstrated in a patient who underwent successful complex thoracoabdominal branched endovascular aortic repair. After the deployment of an aortic endograft with two antegrade branches for the targeted renovisceral vessels, a standard braided sheath was preloaded with a 3/0 polypropylene suture and introduced inside an additional sheath from the groin to the thoracic aorta. Simultaneous gentle traction on the suture as the preloaded sheath was advanced achieved a very stable 180° curve of the proximal end of the sheath. It was possible to selectively catheterize the antegrade branches and respective target vessels sequentially, as well as deploy the planned bridging stents for each branch. Conclusion: The through-and-through suture technique is a helpful tool in branched endovascular aortic repair. It saves time, radiation, and materials; no snare is needed, and it can be preloaded into a sheath.

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Percutaneous femoral access is as safe as femoral cutdown during thoracic endovascular aortic repair

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2011.06.100 ◽

2011 ◽

Vol 213 (3) ◽

pp. S47-S48

Author(s):

James N. Irvine ◽

Castigliano M. Bhamidipati ◽

Damien J. LaPar ◽

John F. Angle ◽

Alan H. Matsumoto ◽

...

Keyword(s):

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Femoral Access ◽

Aortic Repair

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IP257. Percutaneous Femoral Access Associated With Reduced Resource Use After Thoracic Endovascular Aortic Repair for Trauma

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.252 ◽

2019 ◽

Vol 69 (6) ◽

pp. e180-e181

Author(s):

Mark D. Balceniuk ◽

Andrew C. Schroeder ◽

Peng Zhao ◽

Brian C. Ayers ◽

Jennifer L. Ellis ◽

...

Keyword(s):

Resource Use ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Femoral Access ◽

Aortic Repair

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Transcaval Aortic Catheterization for Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Device Delivery

10.1093/med/9780199986071.003.0014 ◽

2018 ◽

Author(s):

Michael D. Dake

Keyword(s):

Aortic Valve ◽

Vena Cava ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Femoral Access ◽

Arterial Access ◽

Transcatheter Aortic Valve ◽

Aortic Repair ◽

Occlusion Device ◽

Vascular Sheath

During the past decade, development of catheter-based techniques for treatment of thoracic aortic and aortic valve pathologies has required that interventionalists focus on the anatomic suitability of vascular access to allow safe introduction of large size devices. Both thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures require 20 French and larger sheaths and most of major complications during these procedures have been access related. This chapter reviews transcaval aortic access techniques for delivering large devices during TEVAR and TAVI. Alternative arterial access or adjunctive femoral access techniques that increase the safety of access and reduce the overall procedural risk for patients with challenging access are critically important for the success of TEVAR or TAVI. The procedure involves transcatheter puncture of the abdominal aorta from the inferior vena cava, with delivery of a large vascular sheath and tract closure post device delivery using a nitinol occlusion device.

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Clinical efficacy and safety of the PRO-glide device as a sUture-mediated ClosurE in Thoracic EndoVascular Aortic Repair in patients with previous groin intervention (from the PRODUCE-TEVAR Trial)

Vascular ◽

10.1177/1708538120949669 ◽

2020 ◽

pp. 170853812094966

Author(s):

Ömer Çelik ◽

Ahmet Anıl Şahin ◽

Ahmet Güner ◽

Ali Rıza Demir ◽

Nedim Uzun ◽

...

Keyword(s):

Femoral Artery ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Exclusion Criterion ◽

Technical Failure ◽

Femoral Access ◽

Femoral Approach ◽

Aortic Repair ◽

Significant Difference ◽

History Of

Background While the percutaneous approach is increasingly preferred, suture-mediated closure devices have been put into clinical practice to close the femoral artery during procedures requiring a large-sized introducer. However, scar in the groin is considered a contraindication or an exclusion criterion for percutaneous procedures. The aim of our study was to investigate the outcomes and safety of Pro-Glide device as suture-mediated closure device in patients who underwent thoracic endovascular aortic repair with percutaneous femoral access ≥22 F who had previous groin intervention. Methods A total of 73 patients who underwent endovascular repair with percutaneous femoral access were retrospectively included in the study. Previous groin intervention was defined as history of open surgical access or large sheath insertion (>18 F) to femoral artery because of endovascular or valvular intervention. Patients were divided into two groups as who had previous groin intervention PGI (+) and had not PGI (−). Results A total of 73 patients [60 male (82.2%)] were included in the study. Seventeen patients had PGI, and 56 did not. When groups were compared in terms of sheath sizes, a significantly higher sheath sizes were used in PGI (+) patients (24.5 ± 1.1 F vs. 23.8 ± 0.9 F, p = 0.005). The overall success rate in the femoral approach with pre-close technique was statistically insignificant between two groups (94.1% vs. 96.4%, p = 0.55). One patient in PGI (+) group and two patients in PGI (−) had technical failure for percutaneous femoral approach. One patient (5.9%) in PGI (+) group and one patient (1.8%) in PGI (−) group had femoral complications after the procedures; however, there was no significant difference between the groups in terms of complications (5.9% vs. 1.8%, p = 0.13). Conclusion Pro-Glide device may be a safe and less invasive method for femoral access in patients with PGI and might not be considered as a contraindication for patients with history of PGI.

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