Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland.
Tampere University, Tampere, Finland.
Vasc Endovascular Surg. 2023 Nov;57(8):848-855. doi: 10.1177/15385744231180663. Epub 2023 Jun 5.
The aim of this study is to compare the outcomes of percutaneous femoral closure with the Prostar XL for endovascular aneurysm repair (EVAR) to those of open femoral cutdown, and to evaluate factors which may predict the failure of percutaneous closure.
Patients undergoing endovascular aneurysm repair for an infrarenal abdominal aortic aneurysm between 2005 and 2013 were included. Patient characteristics, anatomic femoral artery measurements, and postoperative complications were recorded retrospectively. Operator experience was defined with a cut-off point of >30 Prostar XL closures performed. Comparisons were made per access site.
A total of 443 access sites were included, with percutaneous closure used in 257 cases (58.0%) and open cutdown in 186 cases (42.0%). The complication rate was 2.7% for the percutaneous and 4.3% for the open cutdown group ( = .482). No significant differences between groups were found with respect to 30-day mortality, wound infections, thrombosis, seromas, or bleeding complications. Fourteen failures (5.4%) of percutaneous closure occurred. The success rates were similar for experienced and unexperienced operators (94.2% vs 95.5%, = .768). Renal insufficiency was more common in the failed than in the successful percutaneous closure group (64.3% vs 24.7%, = .003). Common femoral artery calcification or diameter, BMI, sheath size, or operator experience did not predict failure. No further complications were seen in follow-up CT at 1-3 years postoperatively.
The use of the Prostar XL is safe compared to open cutdown. The success rate is 94.6%. Operator experience, sheath size, obesity, or femoral artery diameter or calcification do not appear to predict a failure of percutaneous closure. Complications seem to occur perioperatively, and late complications are rare.
本研究旨在比较经皮股动脉闭合术（Prostar XL）与开放股动脉切开术在血管内动脉瘤修复（EVAR）中的疗效，并评估可能预测经皮闭合失败的因素。
回顾性纳入 2005 年至 2013 年间行血管内动脉瘤修复的腹主动脉下段患者。记录患者特征、股动脉解剖学测量值和术后并发症。以 Prostar XL 操作>30 次作为术者经验的分界点。比较两种入路的结果。
共纳入 443 个入路，其中 257 例（58.0%）采用经皮闭合，186 例（42.0%）采用开放股动脉切开术。经皮组和开放组的并发症发生率分别为 2.7%和 4.3%（=0.482）。两组在 30 天死亡率、伤口感染、血栓形成、血清肿或出血并发症方面无显著差异。14 例（5.4%）经皮闭合失败。经验丰富和经验不足的术者的成功率相似（94.2%比 95.5%，=0.768）。失败的经皮闭合组较成功组更常见肾功能不全（64.3%比 24.7%，=0.003）。股总动脉钙化或直径、BMI、鞘管大小或术者经验均不能预测失败。术后 1-3 年随访 CT 未见进一步并发症。
与开放股动脉切开术相比，Prostar XL 的应用是安全的。成功率为 94.6%。术者经验、鞘管大小、肥胖或股动脉直径或钙化似乎不能预测经皮闭合失败。并发症似乎发生在围手术期，晚期并发症罕见。
