Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany.
Department of Vascular and Endovascular Surgery, Marienhospital Gelsenkirchen, Germany.
Vasc Endovascular Surg. 2024 Feb;58(2):129-135. doi: 10.1177/15385744231189356. Epub 2023 Jul 14.
Endovascular aortic repair (EVAR) for elective and emergency infrarenal aortic pathologies is the primary approach for treatment nowadays. During such procedure, the suture-mediated closure device (SMCD) (Perclose ProGlide, Abbott Laboratories, Chicago, IL, USA) is commonly used. This study aimed to identify potential contributors for SMCD failure in a patient cohort of elective and emergency EVAR.
Archived medical records from patients who underwent EVAR for aortic pathologies in elective and emergency setting at the University Hospital Düsseldorf, Germany were included. Patient's co-morbidities, access vessel morphologies and hemostasis-related blood parameters were evaluated on their association with SMCD failure applying different statistical methods.
A total of 71 patients (139 femoral accesses) was included. The mean age was 73.5 ± 8.4 years. Overall SMCD failure rate was 4.3%, 4.1% for elective and 5.9% for emergency cases, respectively. Total procedure time was longer for the SMCD failure group (323 ± 117.8 min vs 171 ± 43.7 min). The calcification status of the common femoral artery (CFA), the diameter of the aortic bifurcation, and dual anti-platelet therapy (DAPT) on the medication plan prior to the procedure were associated with SMCD failure. Univariate binary logistic regression analysis nominated several potentially relevant predictors for SMCD failure who underwent subsequent multivariable binary logistic regression analysis. Here, DAPT on the medication plan was identified as being promising in predicting SMCD failure (OR 30.5), while anterior plaque formation in the CFA maintained as only statistically relevant determinant (OR 44.9).
This study confirms the CFA calcification status to be associated with SMCD failure. Although discontinued prior to endovascular treatment, DAPT was also found to be associated with SMCD failure. Our results may advocate to perform obligatory platelet testing prior to EVAR to maximize patient safety.
腔内主动脉修复术（EVAR）治疗择期和紧急肾下主动脉病变是目前的主要治疗方法。在此过程中，通常使用缝合介导的闭合装置（SMCD）（Perclose ProGlide，雅培实验室，芝加哥，IL，美国）。本研究旨在确定择期和紧急 EVAR 患者队列中 SMCD 失败的潜在因素。
纳入德国杜塞尔多夫大学医院接受择期和紧急 EVAR 治疗的主动脉病变患者的存档病历。应用不同的统计方法评估患者的合并症、入路血管形态和与止血相关的血液参数与 SMCD 失败的关系。
共纳入 71 例患者（139 例股动脉入路）。平均年龄为 73.5 ± 8.4 岁。总的 SMCD 失败率为 4.3%，择期组为 4.1%，急诊组为 5.9%。SMCD 失败组的总手术时间较长（323 ± 117.8 分钟比 171 ± 43.7 分钟）。股总动脉（CFA）的钙化状态、主动脉分叉直径以及术前药物治疗计划中的双联抗血小板治疗（DAPT）与 SMCD 失败相关。单变量二元逻辑回归分析提名了几个潜在相关的预测因子，用于随后的多变量二元逻辑回归分析。在这里，药物治疗计划中的 DAPT 被确定为预测 SMCD 失败的有希望的因素（OR 30.5），而 CFA 中的前斑块形成仍然是唯一具有统计学意义的决定因素（OR 44.9）。
本研究证实 CFA 钙化状态与 SMCD 失败相关。尽管在血管内治疗前已停止使用，但 DAPT 也与 SMCD 失败相关。我们的研究结果可能主张在 EVAR 前进行强制性血小板检测，以最大限度地提高患者的安全性。
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