Haemostasis for 568 large femoral artery access sites-outcomes and predictors of success [Blutstillung nach 568 arterienoperationen - ergebnisse und erfolgspr?diktoren]

摘要

Background: The introduction of stent grafts for thoracic and abdominal aorta (T/EVAR) has raised the demand for percutaneous closure devices for larger femoral arterial access sites. The aim of our study was to evaluate the success and complication rate of completely percutaneous T/EVAR with Prostar XL? and surgical haemostasis over a 50- month period. Patients and methods: Between December 16th 2005 and February 17th 2010 T/EVAR was performed in 306 patients with 568 arterial access sites with diameters of 12 to 24 Fr. The exclusion criteria for percutaneous haemostasis were a calcif ed anterior wall at the puncture site and/or a stenotic common femoral artery, seen on computed tomographic angiography. Results: Surgical haemostasis was performed in 184 (32.4%, o-T/EVAR group) while percutaneous haemostasis was attempted at 384 sites (67.6%, p-T// EVAR group). Most of the procedures were elective; five of twelve emergency patients had percutaneous haemostasis that was successful in all. Percutaneous haemostasis failed at 23 sites. No data about follow-up was recorded for 54 sites (9,5%). The technical success rate of percutaneous haemostasis was 93.6% (338/361 sites). A larger size of the access site resulted in significantly more complications of haemostasis in both groups (p-T/EVAR group p = 0.019; o-T/EVAR group p = 0.003). p-T/EVAR caused more mild complications compared to o-T/EVAR (p = 0.03). No deaths as consequence of failed haemostasis were recorded. Conclusions: Complete percutaneous T/EVAR is technically feasible and safe in a majority of patients. Good patient selection based on adequate pre-procedural imaging and technical expertise of the operators are key to success. Surgical back-up is strongly recommended to assist in those patients in whom p-T/EVAR fails.