Abstract
The percutaneous approach of endovascular repair of aortic aneurysms consists of use of closure devices such as the Prostar XL 10F system. The technique is safe and reproducible. The experience of the surgeon, the presence of severe calcification of the common femoral artery and scarring in the groin after previous vascular operation are significant predictors for failure of hemostasis. Contrariwise, obesity and size of the introducer system seem not to have a relevant association with suboptimal results of the endovascular percutaneous approach.
Keywords
common femoral artery, endovascular repair of aortic aneurysms, percutaneous approach, prostar system
The endovascular treatment of aortic aneurysms is based on stent-graft delivery through the common femoral artery (CFA). The procedure has evolved over the years. Since the development of the percutaneous approach in the late 1990s, several surveys have been performed and have promoted the advantages of this technique. The percutaneous approach was associated with a shorter time to ambulation and fewer complications compared with an open cutdown to the groin vessels, including a reduced risk of events such as wound infection, lymphocele, and hematomas.
All currently available closure devices are approved for use only up to 10-French (10F) sheath sizes. With the introduction of the “preclose” technique, however, it was possible to close access vessels after endovascular aneurysm repair (EVAR), which requires larger-bore sheaths.
The Prostar XL 10F device (Abbott Laboratories. Abbott Park, Illinois, USA) consists of four components ( Fig. 1.1 ). The first two components are a hydrophilic catheter for guiding the system into the aorta and a marker lumen for identification of correct device position in the vessel ( Fig. 1.2 ). The third component is a sheath containing four lancelike nitinol needles, which are connected to two braided sutures ( Fig. 1.3 ). The fourth component is a rotating barrel for dissection and needle capture. The device is advanced into the artery to guide the needle trajectory through the subcutaneous tissue, with the sutures being pulled out from the inside through the arterial wall ( Figs. 1.4 and 1.5 ).
