Percutaneous closure of femoral artery access sites in endovascular stent-graft treatment of aortic disease

Abstract

BACKGROUND: Endovascular techniques using various stent-graft systems are now available to treat aortic disease. Because stent-grafts need large-bore sheaths, arterial surgical cut-downs for access and closure are required. This study describes and reports the results of a percutaneous technique using multiple Perclose devices (Closer-S, 6 Fr) for large arteriotomy closure.

METHODS: Sixty-six patients (50 males; mean age 62.8+/-11.8 years) with endovascular stent-graft treatment (from Feb. 2004 to Jan. 2006) were studied. A total of 92 femoral sites were required for large-bore (larger than 14 Fr) sheaths insertion. Stent-graft devices were introduced through 20 Fr (n=8), 18 Fr (n=29), 16 Fr (n=29) or 14 Fr (n=26) sheaths. After deployment of 2 or 3 Percloses (Closer-S, 6 Fr), arteriotomies were dilated to create an appropriate size for large-bore sheaths insertion. After stent-graft insertion, hemostasis was achieved using multiple Perclose sutures placed prior to arterial dilatation. All femoral sites were followed with physical examination and CT angiography.

RESULTS: Percutaneous closures with 2 or 3 Perclose devices were successful in 95.7% (88/92) of femoral sites, without complication of hematoma, infection, pseudoaneurysm, or arterial thromboses. In 4.3% (4/92), arterial complications requiring vascular surgical repair occurred.

CONCLUSION: Percutaneous closure technique using 2 or 3 Perclose devices placed prior to arterial dilatation is useful for hemostasis in endovascular stent-graft treatment of aortic disease.