Predictors of Failure of Closure in Percutaneous EVAR Using the Prostar XL Percutaneous Vascular Surgery Device

Objective To identify predictors of failure in percutaneous endovascular aneurysm repair (P-EVAR) using the Prostar XL Percutaneous Vascular Surgery Device (Abbot Vascular, Santa Clara, CA, USA) and the need for conversion to conventional femoral cutdown (O-EVAR). Methods Consecutive patients who un...

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Bibliographic Details
Published in:	European journal of vascular and endovascular surgery Vol. 49; no. 1; pp. 45 - 49
Main Authors:	Rijkée, M.P, Statius van Eps, R.G, Wever, J.J, van Overhagen, H, van Dijk, L.C, Knippenberg, B
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-01-2015
Subjects:	Aged Angiography Aortic aneurysm Blood Vessel Prosthesis Implantation Calcinosis - diagnostic imaging Calcinosis - surgery Endovascular procedure Endovascular Procedures - instrumentation Equipment Design Equipment Failure Analysis Feasibility Studies Female Femoral Artery - diagnostic imaging Femoral Artery - surgery Follow-Up Studies Humans Length of Stay Logistic Models Male Percutaneous closure Surgery Tomography, X-Ray Computed Treatment Outcome Endovascular procedure Aortic aneurysm Percutaneous closure
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Summary:	Objective To identify predictors of failure in percutaneous endovascular aneurysm repair (P-EVAR) using the Prostar XL Percutaneous Vascular Surgery Device (Abbot Vascular, Santa Clara, CA, USA) and the need for conversion to conventional femoral cutdown (O-EVAR). Methods Consecutive patients who underwent P-EVAR with the Prostar XL device between January 2009 and April 2012 were included in this series. Patients with a circular calcified common femoral artery (CFA) on computed tomography angiography were operated using O-EVAR and were therefore excluded. To identify predictors of success of closure in P-EVAR, artery characteristics, sheath size used, and comorbidities were analyzed in a univariate logistic regression model. Results Percutaneous access was achieved in 154 femoral access sites with conversion to O-EVAR was needed in 10 (6.5%). Significant predictors of conversion included sheath size (continuous, relative risk [RR] 1.50, p < .03) and the ratio between sheath size and CFA diameter >0.75 (RR 8.93, p < .01). Variables such as calcification quantity scores, CFA diameter, body mass index, and comorbidities were not significant. Conclusion The data demonstrate that sheath size, in particular, combined with CFA diameter predicts failure of closure in P-EVAR using the Prostar XL device. This ratio can be utilized to help in decision making with regard to the EVAR approach. A ratio of >0.75 would favor a primary open groin approach.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1078-5884 1532-2165
DOI:	10.1016/j.ejvs.2014.10.017