Comparison of efficacy and safety of percutaneous and surgical transfemoral access for large-bore devices
Abstract
The
common femoral artery (CFA) is standard approach for endovascular aortic repair
and transcatheter aortic valve implantation. Access could be obtained using
surgical or percutaneous techniques. In this work we investigated the efficacy
and safety of minimally invasive percutaneous and surgical approach to CFA.
Material
and methods. 263 surgical
interventions (endovascular aortic repair and transcatheter aortic valve
implantation) were retrospectively analyzed. We compared surgical time, length
of stay, contrast media volume, large hematomas (greater than 5 cm),
pseudoaneurysms, acute lower limb ischemia, infectious complications,
lymphorrhea, and bleeding that required blood transfusion.
Results
and discussion. The mean length
of stay was 6.2±1.4 days for percutaneous approach with mean difference -1 day
(p<0.0001) compared with surgical. The mean surgical time was
113.5±46.8 minutes for percutaneous approach with mean difference -50.7 minutes
(p<0.0001) compared with surgical. Mean contrast media volume was
153.5±49.9 mL for percutaneous approach with mean difference +3.3 mL (p=0.674)
compared with surgical access. Conversion rate was 4% (8 cases), the rate of
additional VCD was 34% (72 cases). When assessing the effect of calcification
and reaccess on the use of additional VCD, no significant difference was found,
p=0.184 and p=0.634 for calcification and reaccess respectively.
There was one case of significant stenosis requiring endovascular or surgical
correction and one significant bleeding requiring blood transfusion in each
group. One case of infectious complication and lymphorrhea in surgical access
group. Two patients in the percutaneous group had hematoma over 5 cm according
to postoperative ultrasound imaging. There was no procedural or hospital mortality
observed.
Conclusion.
The minimally
invasive percutaneous transfemoral access for large-bore devices is comparable
with the surgical access in terms of efficacy and safety. Its routine use is
reasonable in patients with suitable anatomy.
Keywords:minimally invasive percutaneous transfemoral access; vascular closure devices
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Polyakov R.S., Popov S.O., Chargaziia Sh.G., Kur-ipa
K.A., Puretskiy M.V., Mardanyan G.V., Pirkova A.A., Charchyan E.R., Abugov S.A.
Comparison of efficacy and safety of percutaneous and surgical transfemoral
access for large-bore devices. Clinical and Experimental Surgery. Petrovsky
Journal. 2023; 11 (2): 17–23. DOI: https://doi.org/10.33029/2308-1198-2023-11-2-17-23
(in Russian)
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