Optimizing Femoral Access in Emergency EVAR with a Decision-Making Algorithm
Author:
Mirabella Domenico1, Bruno Salvatore1, La Marca Manfredi Agostino1, Dinoto Ettore1ORCID, Rodriquenz Edoardo1, Miccichè Andrea1, Pecoraro Felice12ORCID
Affiliation:
1. Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy 2. Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90133 Palermo, Italy
Abstract
Endovascular aneurysm repair (EVAR) has become the preferred approach over open repair for abdominal aortic aneurysms (AAAs) due to its minimally invasive nature. The common femoral artery (CFA) is the main access vessel for EVAR, with both surgical exposure and percutaneous access being utilized. However, in emergent cases, percutaneous access can be challenging and may result in complications such as bleeding or dissection thrombosis, leading to the need for surgical conversion. This study aimed to share experiences in implementing a decision-making algorithm to reduce surgical conversions due to percutaneous access failures. A total of 74 aortic patients treated with EVAR in emergency settings were included in this retrospective study. This study focused on various outcomes such as perioperative mortality, morbidity, procedure time, surgical exposure time, and surgical conversion rate. After the implementation of the decision-making algorithm, decreases in surgical conversions and operating time were observed. Percutaneous access was found to be more challenging in cases with specific anatomical characteristics of the CFA, such as severe atherosclerosis or smaller vessel diameter. This study highlighted the importance of carefully assessing patient anatomical features and utilizing a decision-making algorithm to optimize outcomes in EVAR procedures. Further research is needed to continue improving practices for managing aortic aneurysms and reducing complications in femoral artery access approaches.
Reference45 articles.
1. Outcome of elec-tive endovascular abdominal aortic aneurysm repair in octoge-narians and nonagenarians;Prenner;J. Vasc. Surg.,2010 2. Mirabella, D., Evola, S., Dinoto, E., Setacci, C., Pakeliani, D., Setacci, F., Annicchiarico, P., and Pecoraro, F. (2023). Outcome Analysis of Speed Gate Cannulation during Standard Infrarenal Endovascular Aneurysm Repair. J. Clin. Med., 12. 3. Comparing and Correlating Outcomes between Open and Percutaneous Access in Endovascular Aneurysm Repair in Aortic Aneurysms Using a Retrospective Cohort Study Design;DeVito;Int. J. Vasc. Med.,2020 4. Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does Not Affect Major Morbidity or Mortality;Cheng;Ann. Vasc. Surg.,2021 5. Zhou, Y., Wang, J., Zhao, J., Yuan, D., Weng, C., Wang, T., and Huang, B. (2022). The effect of percutaneouS vs. cutdoWn accEss in patients after Endovascular aorTic repair (SWEET): Study protocol for a single-blind, single-center, randomized controlled trial. Front. Cardiovasc. Med., 9.
|
|