At the Abbott Satellite Symposium, yesterday, Ian Loftus (London, UK) reviewed the data for percutaneous closure in endovascular aortic procedures, stating that the percutaneous closure approach was “technically feasible in most cases, is safe, and leads to early mobilisation and reduced length of stay”
Loftus explained that with endovascular aortic aneurysm repair (EVAR), the traditional femoral cutdown for vessel access was still used in many cases. He commented: “Studies have demonstrated groin complication rates ranging from 5% to 15% associated with femoral cutdowns, including wound infections and lymphatic leaks. This can hinder recovery and lead to prolonged length of stay.”
He added that a percutaneous approach using arterial closure devices could potentially avoid many of these complications. Loftus reported: “Previous series and a single small randomised trial have demonstrated high technical success rates and significantly shorter operation times, quicker time to ambulation, reduced length of stay and reduced overall procedural costs associated with using the Abbott Prostar XL device [for percutaneous closure].”
According to Loftus, data from a US multicentre randomised clinical trial comparing percutaneous closure using the Proglide closure device (Abbott Vascular) with standard surgical cutdown found that major access site complications were significantly lower in the percutaneous group (6% vs. 10% for surgical cutdown) and that minor complications were halved (4% vs. 8%). He added: “There was also a significantly shorter procedural time (106 vs. 141 minutes) and time to haemostasis (10 vs. 23 minutes).”
Concluding, Loftus stated: “Complete percutaneous treatment is technically feasible in most cases, is safe and leads to early mobilisation and reduced length of stay”. He commented that the complication profile of this approach was different form the open approach, but said complications could be minimised with “prudent case selection, training and careful device deployment.”
Also at the “Close with confidence” symposium, Matt Thompson (London, UK) spoke about “tips and tricks” for percutaneous closure. These tips included being aware of blood clots, the importance of being patient, and advice on accessing the common femoral artery. He said: “Getting the correct puncture site is absolutely key to a successful procedure. Ultrasound is the best way of ensuring accuracy of puncture.” He concluded that the percutaneous approach was now the default approach for all endovascular procedures at his centre (St George’s Vascular Institute, London) and they had seen an improvement in patient outcomes after adopting the approach. Thompson added there was “definitely a learning curve” with the percutaneous closure approach.