Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
European Vascular Center Aachen-Maastricht, Aachen, Germany.
J Endovasc Ther. 2023 Oct;30(5):730-738. doi: 10.1177/15266028221092980. Epub 2022 May 6.
Percutaneous femoral artery access is being increasingly used in endovascular aortic repair (EVAR). The technique can be challenging in patients with previously surgically exposed or repaired femoral arteries because of excessive scar tissue. However, a successful percutaneous approach may cause less morbidity than a "re-do" open femoral approach. The aim of this study was to assess the impact of prior open surgical femoral exposure on technical success and clinical outcomes of percutaneous approach.
This study retrospectively reviewed the clinical data of patients who underwent percutaneous EVAR between 2010 and 2020 at 2 major aortic centers. Patients were divided into 2 groups (with or without prior open surgical femoral access) for analysis of clinical outcomes. Only punctures with sheaths ≥12Fr were included for analysis. The access and (pre)closure techniques were similar in both institutions. Primary end points were intraoperative technical success, access-related revision, and access complications. A multivariate analysis was performed to identify determinants of conversion to open approach and femoral access complications in intact and re-do groins.
A total of 632 patients underwent percutaneous (complex) EVAR: 98 had prior open surgical femoral access and 534 patients underwent de novo femoral percutaneous access. A total of 1099 femoral artery punctures were performed: 149 in re-do and 950 in intact groins. The extent of endovascular repair included 159 infrarenal, 82 thoracic, 368 fenestrated/branched, and 23 iliac branch devices. No significant differences were seen in technical success (re-do 93.3% vs intact 95.3%, p=0.311), access-related surgical revision (0.7% vs 0.6%, p=0.950), and access complications (2.7% vs 4.0%, p=0.443). For the whole group, significant predictors for access complications in multivariate analyses were main access site (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.07%-5.35%; p=0.033) and increase of the procedure time per hour (OR 1.65; 95% CI 1.34%-2.04%; p<0.001), while increase in sheath-vessel ratio had a protective effect (OR 0.33; 95% CI 0.127%-0.85%; p=0.021). Surgical conversion was predicted by main access site (OR 2.32; 95% CI 1.28%-4.19%; p=0.007) and calcification of 50% to 75% of the circumference of the access vessel (OR 3.29; 95% CI 1.38%-7.86%; p=0.005).
Within our population prior open surgical femoral artery exposure or repair had no negative impact on the technical success and clinical outcomes of percutaneous (complex) endovascular aortic aneurysm repair.
经皮股动脉入路在血管内主动脉修复术（EVAR）中应用越来越广泛。由于有过多的疤痕组织，在先前接受过手术暴露或修复的股动脉患者中，该技术可能具有挑战性。然而，成功的经皮入路可能比“再次”开放股动脉入路引起的发病率更低。本研究旨在评估先前开放手术股动脉暴露对经皮入路技术成功和临床结果的影响。
本研究回顾性分析了 2010 年至 2020 年间在 2 个主要主动脉中心接受经皮 EVAR 的患者的临床资料。将患者分为两组（有或无先前的开放手术股动脉入路）进行临床结果分析。仅对鞘≥12Fr 的穿刺进行分析。两个机构的入路和（术前）闭合技术相似。主要终点为术中技术成功、与入路相关的修正和入路并发症。进行多变量分析以确定在完整和再修复股gro中转换为开放方法和股动脉入路并发症的决定因素。
共有 632 名患者接受了经皮（复杂）EVAR：98 名患者有先前的开放手术股动脉入路，534 名患者接受了新的股动脉经皮入路。共进行了 1099 次股动脉穿刺：149 次在再修复股gro，950 次在完整股gro。血管内修复的范围包括 159 例肾下，82 例胸，368 例开窗/分支，和 23 例髂动脉分支装置。在技术成功（再修复 93.3%与完整 95.3%，p=0.311）、与入路相关的手术修正（0.7%与 0.6%，p=0.950）和入路并发症（2.7%与 4.0%，p=0.443）方面，无显著差异。在多变量分析中，对整个组而言，入路并发症的显著预测因子是主要入路部位（优势比[OR]2.39；95%置信区间[CI]1.07%-5.35%；p=0.033）和每小时手术时间的增加（OR 1.65；95%CI 1.34%-2.04%；p<0.001），而鞘管-血管比的增加具有保护作用（OR 0.33；95%CI 0.127%-0.85%；p=0.021）。手术转换由主要入路部位（OR 2.32；95%CI 1.28%-4.19%；p=0.007）和血管入路部位 50%至 75%的钙化（OR 3.29；95%CI 1.38%-7.86%；p=0.005）预测。
在我们的人群中，先前的开放股动脉暴露或修复对经皮（复杂）血管内主动脉瘤修复的技术成功和临床结果没有负面影响。
