Femoral arterial preclosure by purse-string suture for thoracic endovascular aortic repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAN Bicheng ,  LIU Jian , CHEN Jian

Department of Cardiothoracic Surgery, Anqing Municipal Hospital, Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui, P.R.China;

Corresponding author：

LIU Jian, Email: liujianaqslyy@126.com

Keywords：

Endovascular aortic repair; femoral artery; purse-string; preclose technique

DOI：

10.7507/1007-4848.201611011

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the safety and efficacy of the femoral arterial preclosure by purse-string suture for thoracic endovascular aortic repair (TEVAR). Methods From January 2013 to September 2016, TEVAR was performed on 40 patients with Standford type B aortic dissection. There were 34 males and 6 females aged 57.9±10.4 years. According to the surgical procedure, they were divided into a purse-string group (20 patients, 16 males, 4 females, aged 58.1±10.3 years), in which the patients received femoral arterial preclosure by purse-string suture and a convention group (20 patients, 18 males, 2 females, aged 57.7±10.8 years), in which the patients underwent conventional femoral cutdown. The outcomes and complications of two groups were evaluated. Results There was no in-hospital death and no paraplegia event. There was significantly shorter operation time (70.4±24.0 min vs. 100.8±35.6 min, P=0.003) and less blood loss (39.5±29.8 ml vs. 83.5±86.5 ml, P=0.038) in the purse-string group than those in the convention group. Femoral artery stenosis was observed in 3 patients (15.0%) in the convention group and none in the purse-string group during the follow-up of 1-36 (17.2±11.5) months with no statistical difference (P=0.231). Conclusion Using the femoral arterial preclosure by purse-string suture for TEVAR can save operation time, reduce intraoperative bleeding and decrease the approach-associated complications.

Citation： ZHAN Bicheng, LIU Jian, CHEN Jian. Femoral arterial preclosure by purse-string suture for thoracic endovascular aortic repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(9): 721-724. doi: 10.7507/1007-4848.201611011 Copy

1.	Berland TL, Cayne NS, Veith FJ. Access complications during endovascular aortic repair. J Cardiovasc Surg (Torino), 2010, 51(1): 43-52.
2.	Kolluri R, Fowler B, Nandish S. Vascular access complications: diagnosis and management. Curr Treat Options Cardiovasc Med, 2013,15(2): 173-187.
3.	Jim J, Rubin BG, Moon MR,et al. Arterial access for thoracic endograft placement. Ann Vasc Surg, 2010, 24(5): 640-645.
4.	Torsello GB, Kasprzak B, Klenk E, et al. Endovascular suture versus cutdown for endovascular aneurysm repair: a prospective randomized pilot study. J Vasc Surg, 2003, 38(1): 78-82.
5.	Buck DB, Karthaus EG, Soden PA, et al. Percutaneous versus femoral cutdown access for endovascular aneurysm repair. J Vasc Surg, 2015, 62(1): 16-21.
6.	Nelson PR, Kracjer Z, Kansal N, et al. A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial). J Vasc Surg, 2014, 59(5): 1181-1193.
7.	Manunga JM, Gloviczki P, Oderich GS, et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2013, 58(5): 1208-1212.
8.	Brunkwall J, Kasprzak P, Verhoeven E, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg, 2014, 48(3): 285-291.
9.	Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv, 2013, 6(4): 407-416.
10.	Xenos ES, Minion DJ, Davenport DL, et al. Endovascular versus open repair for descending thoracic aortic rupture: institutional experience and meta-analysis. Eur J Cardiothorac Surg, 2009, 35(2): 282-286.
11.	Fattori R, Mineo G, Di Eusanio M. Acute type B aortic dissection: current management strategies. Curr Opin Cardiol, 2011, 26(6): 488-493.
12.	Matsumura JS, Cambria RP, Dake MD, et al. International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results. J Vasc Surg, 2008, 47(2): 247-257.
13.	秦卫, 黄福华, 陈鑫, 等. 术中支架系统治疗复杂 B 型主动脉夹层. 中华胸心血管外科杂志, 2014, 30(6): 353-355.
14.	Hingorani AP, Ascher E, Marks N, et al. Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: an underdiagnosed entity. J Vasc Surg, 2009, 50: 505-509.
15.	詹必成, 刘建, 杜少鸣, 等. 覆膜支架腔内隔绝术治疗 Stanford B 型主动脉夹层. 中国胸心血管外科临床杂志, 2013, 20(3): 360-361.
16.	Cochennec F, Becquemin JP, Desgranges P, et al. Limb graft occlusion following EVAR: clinical pattern, outcomes and predictive factors of occurrence. Eur J Vasc Endovasc Surg, 2007, 34(1): 59-65.

1. Berland TL, Cayne NS, Veith FJ. Access complications during endovascular aortic repair. J Cardiovasc Surg (Torino), 2010, 51(1): 43-52.
2. Kolluri R, Fowler B, Nandish S. Vascular access complications: diagnosis and management. Curr Treat Options Cardiovasc Med, 2013,15(2): 173-187.
3. Jim J, Rubin BG, Moon MR,et al. Arterial access for thoracic endograft placement. Ann Vasc Surg, 2010, 24(5): 640-645.
4. Torsello GB, Kasprzak B, Klenk E, et al. Endovascular suture versus cutdown for endovascular aneurysm repair: a prospective randomized pilot study. J Vasc Surg, 2003, 38(1): 78-82.
5. Buck DB, Karthaus EG, Soden PA, et al. Percutaneous versus femoral cutdown access for endovascular aneurysm repair. J Vasc Surg, 2015, 62(1): 16-21.
6. Nelson PR, Kracjer Z, Kansal N, et al. A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial). J Vasc Surg, 2014, 59(5): 1181-1193.
7. Manunga JM, Gloviczki P, Oderich GS, et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2013, 58(5): 1208-1212.
8. Brunkwall J, Kasprzak P, Verhoeven E, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg, 2014, 48(3): 285-291.
9. Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv, 2013, 6(4): 407-416.
10. Xenos ES, Minion DJ, Davenport DL, et al. Endovascular versus open repair for descending thoracic aortic rupture: institutional experience and meta-analysis. Eur J Cardiothorac Surg, 2009, 35(2): 282-286.
11. Fattori R, Mineo G, Di Eusanio M. Acute type B aortic dissection: current management strategies. Curr Opin Cardiol, 2011, 26(6): 488-493.
12. Matsumura JS, Cambria RP, Dake MD, et al. International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results. J Vasc Surg, 2008, 47(2): 247-257.
13. 秦卫, 黄福华, 陈鑫, 等. 术中支架系统治疗复杂 B 型主动脉夹层. 中华胸心血管外科杂志, 2014, 30(6): 353-355.
14. Hingorani AP, Ascher E, Marks N, et al. Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: an underdiagnosed entity. J Vasc Surg, 2009, 50: 505-509.
15. 詹必成, 刘建, 杜少鸣, 等. 覆膜支架腔内隔绝术治疗 Stanford B 型主动脉夹层. 中国胸心血管外科临床杂志, 2013, 20(3): 360-361.
16. Cochennec F, Becquemin JP, Desgranges P, et al. Limb graft occlusion following EVAR: clinical pattern, outcomes and predictive factors of occurrence. Eur J Vasc Endovasc Surg, 2007, 34(1): 59-65.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Femoral arterial preclosure by purse-string suture for thoracic endovascular aortic repair

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