Percutaneous versus femoral cutdown access for XXXX repair.

@entity1 @entity712 @entity281 @entity397 @entity439 @entity1028
OBJECTIVE: Prior studies suggest that percutaneous access for @entity1028 repair (pEVAR) offers significant operative and postoperative benefits compared with femoral cutdown (cEVAR). National data on this topic, however, are limited. We compared @entity1 selection and outcomes for elective pEVAR and cEVAR. METHODS: We identified all @entity1 undergoing either pEVAR (bilateral percutaneous access, whether successful or not) or cEVAR (at least one planned groin cutdown) for @entity1028 from January 2011 to December 2013 in the Targeted Vascular data set from the American College of Surgeons National Surgical Quality Improvement Program database. Emergent cases, @entity397 , cases with an iliac conduit, and cases with a preoperative wound @entity281 were excluded. Groups were compared by   (2) test or t-test or the Mann-Whitney test where appropriate. RESULTS: We identified 4112 @entity1 undergoing elective EVAR, 3004 cEVAR @entity1 (73%) and 1108 pEVAR @entity1 (27%). Of all EVAR @entity1 , 26% had bilateral percutaneous access; 1.0% had attempted percutaneous access converted to cutdown (4% of pEVARs); and the remainder had a planned cutdown, 63.9% bilateral and 9.1% unilateral. There were no significant differences in age, gender, @entity439 diameter, or prior open abdominal surgery. @entity1 undergoing cEVAR were less likely to have @entity712 (1.5% vs 2.4%; P  = .04) but more likely to undergo any concomitant procedure during surgery (32% vs 26%; P  < .01) than @entity1 undergoing pEVAR. Postoperatively, pEVAR @entity1 had shorter operative time (mean, 135 vs 152  minutes; P  < .01), shorter length of stay (median, 1  day vs 2  days; P  < .01), and fewer wound complications (2.1% vs 1.0%; P  = .02). On multivariable analysis, the only predictor of percutaneous access failure was performance of any concomitant procedure (odds ratio, 2.0; 95% confidence interval, 1.0-4.0; P  = .04). CONCLUSIONS: Currently, one in four @entity1 treated at Targeted Vascular National Surgical Quality Improvement Program centers are getting pEVAR, which is associated with a high success rate, shorter operation time, shorter length of  stay, and fewer wound complications compared with cEVAR.
