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Safety and Feasibility of Percutaneous Purse-String-Like Downsizing for Femoral Access During Complex Endovascular Aortic Repair

  • Technical Note
  • Arterial Interventions
  • Published:
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Abstract

Purpose

To describe a percutaneous “purse-string-like” technique to downsize the femoral access sheath achieving early pelvis and limb reperfusion during complex endovascular aortic repair, while maintaining a sheath in place.

Materials and Methods

After ultrasound-guided femoral catheterization, two Perclose ProGlide vascular closure devices (VCD) are employed with the pre-close technique. When the deployment of aortic components is complete, the large delivery sheath is exchanged for a smaller non-occlusive one (≤ 10 F) and the rail suture of both VCDs is pulled to achieve hemostasis. At the end of the procedure, the access is closed according to standard technique.

Results

Fifty-eight femoral accesses were downsized achieving hemostasis with a completion percutaneous closure success of 95% (55/58). The median ischemic time to the limb was 66 min (IQR 31–131) for the main access and 65 min (IQR 30–100) for the contralateral one. When compared to a 1:2 propensity score-matched cohort who did not undergo access downsizing, no differences in closure success were recorded (95% vs. 89%, p = 0.19). However, hemostasis required more frequently an additional ProGlide in the downsizing group (26 cases, 45% vs. 17 cases, 15%; p < .001).

Conclusion

Percutaneous purse-string-like sheath downsizing to restore perfusion to limbs and pelvis during complex endovascular aortic repair is feasible with high closure success rates, although a third ProGlide is more frequently needed to achieve hemostasis. The impact of this practice on SCI rates requires further evaluation in larger series as part of a multimodal approach for spinal cord protection.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Andrea Melloni, Alessandro Grandi, Germano Melissano, Roberto Chiesa & Luca Bertoglio

Authors
  1. Andrea Melloni
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  2. Alessandro Grandi
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  3. Germano Melissano
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  4. Roberto Chiesa
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  5. Luca Bertoglio
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Corresponding author

Correspondence to Luca Bertoglio.

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Conflict of interest

AM, AG, GM, RC and LB have no conflicts of interest to declare that may pertain to the manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

For this retrospective study, formal consent is not required. However, informed consent to the aortic procedures and to the use of anonymous patient data was obtained from all individual participants included in the manuscript.

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Consent for publication was obtained for every individual person’s data included in the study.

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Melloni, A., Grandi, A., Melissano, G. et al. Safety and Feasibility of Percutaneous Purse-String-Like Downsizing for Femoral Access During Complex Endovascular Aortic Repair. Cardiovasc Intervent Radiol 43, 1084–1090 (2020). https://doi.org/10.1007/s00270-020-02508-3

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  • DOI: https://doi.org/10.1007/s00270-020-02508-3

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