Short- and Midterm Results of the Fascia Suture Technique for Closure of Femoral Artery Access Sites After Endovascular Aneurysm Repair

• Published in: Journal of endovascular therapy Vol. 18; no. 6; pp. 789 - 796
• Main Authors: Montán, Carl, Lehti, Leena, Holst, Jan, Björses, Katarina, Resch, Timothy A.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.12.2011; Allen Press Inc
• Subjects: Aged; Cardiac and Cardiovascular Systems; Clinical Medicine; Endovascular Procedures - methods; Failure; Fasciotomy; Female; Femoral Artery - diagnostic imaging; Femoral Artery - surgery; Follow-Up Studies; Humans; Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medical imaging; Medicin och hälsovetenskap; Postoperative Complications; Retrospective Studies; Risk Factors; Surgery; Suture Techniques - adverse effects; Tomography, X-Ray Computed; Treatment Outcome; Veins & arteries; suture; endovascular aneurysm repair; pseudoaneurysm; fascia; outcome analysis; percutaneous technique; vascular closure
• ISSN: 1526-6028; 1545-1550; 1545-1550
• DOI: 10.1583/11-3621.1

Purpose To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Methods Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Results Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm3) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. Conclusion The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.