The Regional Vascular Unit, Royal Liverpool and Broadgreen Hospital, Liverpool, UK.
Eur J Vasc Endovasc Surg. 2011 Mar;41(3):346-9. doi: 10.1016/j.ejvs.2010.11.020. Epub 2010 Dec 8.
There are potential benefits of percutaneous over open femoral access for endovascular aneurysm repair (EVAR). Subsequent arterial closure using percutaneous devices is costly, whilst open repair risks potential wound complications and delayed discharge. The technique of fascial closure has perceived advantages but its efficacy is unclear. The aim of this study was to assess the safety and durability of fascial closure after EVAR.
Patients undergoing EVAR using devices up to 24 French were considered. Exclusion criteria included morbid obesity, high bifurcation, previous surgery, inadvertent high puncture, arteries < 5 mm and surgeon preference. The primary outcome measure was immediate technical success. All patients were followed-up clinically and with duplex at one and twelve months to determine secondary complications.
Over a one-year period fascial closure of 69 common femoral arteries was attempted in 38 patients undergoing EVAR. Nine primary failures were due to haemorrhage in eight arteries and thrombosis in one artery; all had immediate, uncomplicated open revision. Of the 60 (87%) successful procedures, all had duplex surveillance at one month. Four pseudoaneurysms were identified, all treated conservatively. At one year, 61 fascial closures (88%) were imaged, four patients had died and two were lost to follow-up. Three of the pseudoaneurysms had resolved, the fourth patient had died (unrelated). No other complication attributable to fascial closure was found at either one or twelve months.
Fascial closure is a safe, durable and cost-effective method of arterial closure following EVAR. Success and complication rates are comparable to other techniques.
血管内动脉瘤修复术（EVAR）经皮股动脉入路相对于开放股动脉入路具有潜在优势。经皮器械后续动脉闭合较为昂贵，而开放修复存在潜在的伤口并发症和延迟出院风险。筋膜闭合技术具有明显优势，但其实效性尚不清楚。本研究旨在评估 EVAR 后筋膜闭合的安全性和耐久性。
考虑使用最大 24 French 器械进行 EVAR 的患者。排除标准包括病态肥胖、高位分叉、既往手术、意外高位穿刺、动脉直径<5mm 和外科医生偏好。主要结局测量指标为即刻技术成功。所有患者均接受临床和 1 个月及 12 个月的双功能超声检查，以确定次要并发症。
在一年期间，对 38 名接受 EVAR 的患者的 69 条股总动脉进行了筋膜闭合尝试。9 例原发性失败是由于 8 例动脉出血和 1 例动脉血栓形成所致，所有患者均立即进行了简单的开放修复。60 例（87%）成功的手术中，所有患者均在 1 个月时进行了双功能超声检查。发现 4 例假性动脉瘤，均保守治疗。在 1 年时，对 61 例筋膜闭合进行了影像学检查，4 例患者死亡，2 例患者失访。3 例假性动脉瘤已缓解，第 4 例患者死亡（与手术无关）。在 1 个月或 12 个月时，均未发现其他与筋膜闭合相关的并发症。
筋膜闭合是 EVAR 后动脉闭合的一种安全、耐用且具有成本效益的方法。成功率和并发症发生率与其他技术相当。
