Comparison of efficacy and safety of percutaneous and surgical transfemoral access for large-bore devices

• 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.

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

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