A completely percutaneous approach to endovascular abdominal aortic aneurysm (AAA) repair using the “preclose” technique with the Perclose Proglide Suture-Mediated Closure System (Abbott Vascular) was recently presented at Southern Association for Vascular Surgery 2013 with results of the PEVAR (Percutaneous EVAR) Trial. The primary endpoint was met, demonstrating noninferiority of PEVAR to surgical EVAR that persisted through 6 months. Mean procedural time was reduced in PEVAR by 34 minutes, mean time to hemostasis was reduced by 13 minutes, and other benefits were noted as well.
Dr. George presents a case of EVAR performed percutaneously using a low-profile stent-graft in the August issue of VDM:
A 62-year-old male with a known history of abdominal aortic aneurysm (AAA), coronary artery disease with ischemic cardiomyopathy, hypertension, and dyslipidemia presented to the endovascular clinic for a 6-month follow-up of his AAA. Physical examination was remarkable for a palpable abdominal mass and a soft bruit. Vascular exam was within normal limits with 2+ pulses bilaterally in the femoral, popliteal, and pedal segments. Computed tomography (CT) angiography of the abdomen and pelvis measured the AAA at 5.5 cm in oblique AP diameter (Figure 1) compared to 5.2 cm at preceding study 6 months prior. The iliac and femoral arteries were noted to be large and relatively free of disease. In the setting of a progressively enlarging AAA, a decision was made to perform an endovascular aneurysm repair (EVAR) of the AAA.
See “Totally Percutaneous Endovascular Aneurysm Repair of Abdominal Aortic Aneurysm with a 14 Fr Low-Profile Stent Graft” for details and results of this case and to download a PDF of the article.