Researchers from Oxford suggest that augmentation of the preclose technique (using Proglide from Abbott Vascular) with the Angio-Seal vascular closure device (St Jude Medical) is a safe and effective adjunct for haemostasis that increases the success of percutaneous endovascular aneurysm repair.
James H Briggs, Radiology, Oxford Radcliffe Hospitals Trust, Oxford, UK, presented the results at the British Society of Interventional Radiology (BSIR) annual meeting (13–15 November, Manchester, UK).
Briggs noted that endovascular aortic aneurysm repair (EVAR) is a well-established technique. “More recently, this procedure has been refined to allow treatment via percutaneous access (PEVAR). Percutaneous arteriotomy closure in this context is performed with suture mediated closure devices, most commonly described using the preclose technique. We report our experience of selectively augmenting the preclose technique with an Angio-Seal device in those patients who have continued uncontrolled bleeding after securing the knots of the suture mediated closure devices,” he said.
The researchers prospectively collected data from all patients undergoing EVAR over 21 months. Data recorded included patient demographics, body mass index, depth of common femoral artery from skin, access vessel diameter, degree of vessel calcification, sheath size and history of previous groin surgery. Outcomes include immediate technical success of PEVAR, complications, and duration of hospital stay.
Briggs reported that in 55 patients, aged 60–85, 106 groins were attempted percutaneously. Of these, 80 (75.5%) closed using the preclose technique without Angio-Seal augmentation. Angio-Seal augmentation was used for 21 arterial access sites in 19 patients.
“The average sheath size was 18.25F (inner diameter), mean vessel diameter was 12mm and the mean depth of the common femoral artery from the skin was 3.5cm. Twenty of the access sites were closed successfully, increasing the overall percutaneous closure rate to 94%. One access site required open conversion due to non-engagement of the Angio-Seal footplate. There were no significant early or late complications following Angio-Seal augmented closure of PEVAR. In our experience, Angio-Seal augmentation of the preclose technique reduces open conversions and potential complications of PEVAR,” Briggs said.