ABSTRACT
PURPOSE: This study was designed to assess the feasibility and safety of percutaneous axillary access in complex endovascular aortic repair (EVAR) with use of a percutaneous closure device. MATERIALS AND METHODS: All patients undergoing percutaneous axillary artery access between 2012 and 2017 were included. Left percutaneous axillary access was the sole antegrade aortic approach used. Patient and intervention characteristics were documented. Mortality, procedural success, technical success, peri- and postoperative complications, and repeat interventions were examined. A total of 25 percutaneous axillary access procedures were performed in 23 patients. The mean age of the treated patients was 72.2 years, and 71% were male. Percutaneous axillary access was obtained for a variety of indications (chimney EVAR, thoracoabdominal aortic aneurysm repair, thoracic EVAR, and type B dissections). Vascular access sheath sizes ranged from 6 F to 12 F. RESULTS: The procedural success rate was 96%. Technical success of vascular closure was 100%. The perioperative access complication rate was 8%: 1 dissection of the axillary artery and 1 stenosis occurred. No hematoma, hemorrhage, or neuropathies were seen. One access-related repeat intervention had to be performed. The 30-d mortality rate was 4%. CONCLUSIONS: Direct puncture and percutaneous closure of the axillary artery for complex aortic procedures is safe and feasible.
Subject(s)
Aortic Diseases/surgery , Axillary Artery , Blood Vessel Prosthesis Implantation , Catheterization, Peripheral/methods , Endovascular Procedures , Hemorrhage/prevention & control , Hemostatic Techniques/instrumentation , Vascular Closure Devices , Aged , Aged, 80 and over , Axillary Artery/diagnostic imaging , Blood Vessel Prosthesis Implantation/adverse effects , Catheterization, Peripheral/adverse effects , Endovascular Procedures/adverse effects , Equipment Design , Feasibility Studies , Female , Hematoma/etiology , Hematoma/prevention & control , Hemorrhage/etiology , Hemostatic Techniques/adverse effects , Humans , Male , Middle Aged , Punctures , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Endovascular aneurysm repair (EVAR) has become the primary treatment option for elective abdominal aortic aneurysms. However, a significant number of patients require secondary interventions to maintain adequate aneurysm exclusion and ultimately prevent death from abdominal aortic aneurysm (AAA) rupture. To maintain success and offer timely secondary intervention, intensive image surveillance has been recommended. These rigorous surveillance regimens are costly and may have deleterious effects from radiation and contrast exposure. Improvements in patient selection, operative technique and devices have caused a decline in complications after EVAR. Therefore, there is a need to reduce surveillance after EVAR for patients at lower risk of complications and install individualized follow-up protocols. This review describes the current strategies for surveillance and clarification of risk factors and predictors for late complications and discusses proposed risk-adapted strategies for postoperative surveillance after EVAR.
