Cutdown Technique is Superior to Fascial Closure for Femoral Artery Access after Elective Endovascular Aortic Repair.
OBJECTIVES
Arterial access closure after endovascular aneurysm repair (EVAR) can be achieved using three different approaches: percutaneous closure devices, surgical exposure and direct suture ("cutdown"), and the less invasive fascial closure technique. The aim of this study was to report on the intra-operative, in hospital, and three month outcome of fascial closure and cutdown, and to determine risk factors for failure.


METHODS
The primary outcome was assessed in 439 groins in 225 elective EVAR patients recruited consecutively and prospectively from February 1, 2011 to August 31, 2014. During the study period, fascial closure and cutdown were first and second line closing techniques. Compared with fascial closure, procedures completed with cutdown had lower BMI, thinner subcutaneous tissue of the groin and more complex femoral anatomy. Computed tomographic angiography (CTA) and duplex ultrasound (DUS) of the groin were performed pre-operatively and three months after EVAR. Retrospective review of medical records and CTA were used to determine intra-operative and in hospital outcome, and risk factors for failure.


RESULTS
In total, 64%, 33%, and 3% were completed with fascial closure, cutdown, and closure device, respectively. Intra-operative, in hospital, and three month technical success rates of fascial closure vs. cutdown were 91% (283/310 groins) vs. 99% (114/115 groins), 89% (277/310 groins) vs. 99% (114/115 groins), and 89% (275/310 groins) vs. 99% (114/115 groins) (p < .001). Wound complications within three months were infrequent for both methods. No risk factor was significantly associated with failure after fascial closure.


CONCLUSION
This study shows that cutdown is superior to fascial closure for femoral artery access after elective EVAR. In acute EVAR, however, fascial closure is still considered to be a good and fast method, and it has been kept in the present authors' armamentarium for this indication.
['Fredholm|Kristian|K|', 'Eiberg|Jonas P|JP|', 'Lönn|Lars|L|', 'Vogt|Katja C|KC|', 'Sillesen|Henrik H|HH|', 'Bredahl|Kim K|KK|']
D000368:Aged D017544:Aortic Aneurysm, Abdominal D019917:Blood Vessel Prosthesis Implantation D000072226:Computed Tomography Angiography D017558:Elective Surgical Procedures D057510:Endovascular Procedures D005206:Fascia Lata D005260:Female D005263:Femoral Artery D005500:Follow-Up Studies D006119:Groin D006801:Humans D008297:Male D011183:Postoperative Complications D011446:Prospective Studies D013536:Suture Techniques D013997:Time Factors D016896:Treatment Outcome D018616:Ultrasonography, Doppler, Duplex D062666:Vascular Access Devices
Cutdown Fascial closure EVAR Access complications EVAR-surveillance Fascial suture