To describe a technique for access site closure in percutaneous abdominal aortic aneurysm (AAA) repair using double Perclose ProGlide devices to overcome the problems associated with the bulky delivery system and braided suture of the antecedent (Prostar) device.
After obtaining guidewire access, 2 Perclose ProGlide sutures are deployed at 90 degrees to each other. The appropriate sheaths are placed over the stiff guidewires. After the stent-graft procedure is completed, an assistant holds pressure while the knots are tightened with the stiff guidewire still in the artery. Once the second knot is tightened with the knot pusher and after confirming adequate hemostasis, the wire is removed, pressure is applied, and heparin reversed. This method has been used in 17 consecutive patients (age range 65-85 years) undergoing endovascular AAA repair. One patient needed patch angioplasty and 2 required small incisions for additional suture placements (81% primary success rate for total percutaneous repair, 90% success rate for all sites).
We have found the double Perclose ProGlide technique to be easy to use, safe, and feasible for total percutaneous AAA repair. More experience with longer follow-up is needed to assess its potential to replace the Perclose Prostar closure device for total percutaneous AAA repairs.
[Show abstract][Hide abstract] ABSTRACT: Recent developments in aortic stent-graft technology have led to an increase in the use of wholly percutaneous endovascular aneurysm repair (P-EVAR). The literature was systematically reviewed to analyse the results of P-EVAR.
A systematic review of P-EVAR was performed using Ovid-MEDLINE in-process and other nonindexed citations and Ovid-MEDLINE and EMBASE (January 1991-July 2009). Primary outcomes reviewed were success rate and loco-regional complications. Secondary outcomes included; operative time, hospital stay, time to ambulation, blood loss and cost. Prospective randomised and controlled nonrandomised studies were included as were case series (retrospective and prospective). Case reports, letters, review articles and non-English language articles were excluded.
Twenty-two papers were identified. These included randomised trials (n=1); prospective nonrandomised (n=10) and retrospective studies (n=11). P-EVAR was attempted in 1087 patients (1751 groins). Overall success rate of percutaneous arterial closure was 92% (90.1-93.9, 95% CI). Access related complication rate was 4.4% (3.5-5.3, 95% CI). Seven studies provided data on access related complications in open access cohorts (O-EVAR). In these studies, P-EVAR was associated with fewer access related complications (RR 0.47, 95% CI 0.28-0.78, p=0.004). P-EVAR was associated with reduced operative time.
P-EVAR appears safe and effective in selected patients. Local access related complications were low. Further work is required to identify the most suitable candidates for P-EVAR.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 02/2010; 39(6):676-82. DOI:10.1016/j.ejvs.2010.02.001 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The paper supports the demonstration of a hypermedia based
environment that provides educational material in electric energy
systems engineering. The widely available Web technology is used to
integrate diverse teaching resources such as modular hypertext units,
static images, audio and animation files as well as computer simulation
programs in a structured way. It is shown that the use of hypermedia
based information retrieval systems such as the Netscape Navigator for
disseminating this type of educational material has many advantages that
cannot possibly be achieved by conventional tools
Multi Media Engineering Education, 1996., IEEE International Conference on; 08/1996
[Show abstract][Hide abstract] ABSTRACT: Percutaneous access during endovascular aortic repair has been shown to be feasible and safe using a suture-mediated closure device ("Preclose" technique) for closure of up to 24F introducer sheaths. The purpose of this study is to examine the late outcomes of those femoral arteries repaired in this manner.
The Preclose technique has been previously described. Briefly, the technique involves two Perclose Proglide devices deployed in the femoral artery prior to insertion of the large diameter introducer sheath and then closure of the arteriotomy by tying down knots of the Proglide following removal of the sheath. The medical records of all patients who underwent endovascular aortic repairs using the Preclose technique between December 2004 and August 2007 were reviewed. Follow-up protocol consisted of computed tomography (CT) angiograms performed at 1, 6, and 12 months, and annually thereafter. All Preclose patients who had at least a 6-month postoperative scan were included in the study. For each patient, the most recent postoperative scan was compared with the preoperative scan for evidence of any new anatomic abnormalities of the femoral artery such as dissection, stenosis, or pseudoaneurysm. Three-dimensional post processing with multiplanar reconstructions was also performed as necessary to confirm axial scan findings.
A total of 292 patients underwent percutaneous endovascular aortic repairs (TEVAR-125, EVAR-167). Four hundred thirty-two femoral arteries were closed with 870 devices. Four hundred eighteen vessels were approximated with two devices, while 30 arteries required three devices for hemostasis and an additional four vessels only required a single device. Two hundred seventy-eight (64.3%) vessels were accessed with sheaths 18 to 24F. Four hundred eight femoral arteries (94.4%) were closed successfully with the Preclose technique. There were 100 patients (TEVAR-35, EVAR-65) who had adequate postoperative CT scan at 6-months or later. The mean follow up was 11.6 +/- 5.0 months. Of the 156 femoral arteries in these 100 patients repaired using the Preclose technique, there were 3 late complications in 3 patients, 1 asymptomatic femoral artery dissection, and 2 femoral artery pseudoaneurysms requiring surgical repair, resulting in a late complication rate of 1.92% (3/156).
Percutaneous closure of femoral arteries after large diameter introducer sheaths using the Preclose technique has a low incidence of early and late complications related to the closure site.
Journal of Vascular Surgery 06/2008; 47(5):919-23. DOI:10.1016/j.jvs.2007.12.029 · 3.02 Impact Factor
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