Background: Endovascular techniques are now available for treatment of aortic aneurysm and aortic dissection using various stent-graft systems. Because stent grafts used for endovascular repair of aortic diseases require the use of large-bore sheaths, surgical cut-downs on an artery for assess and closure has been required. This study was to describe our novel percutaneous technique using multiple Perclose devices to close large arteriotomies and report the results.
Methods: The thirty patients (23 men; mean age 63.0 yrs) had stent-graft devices placed for abdominal aortic aneurysm (n=20), thoracic applications (n=4) and aortic dissection (n=6). Total 41 femoral sites were required the use of large-bore (larger than 14 Fr) sheaths. The devices were introduced through 20 Fr (n=6), 18 Fr (n=13), 16 Fr (n=9) or 14 Fr (n=13) sheaths. After Perclose deployment, the arteriotomies were dilated to the appropriate sizes for the development sheaths. After stent-graft deployment, hemostasis was achieved by the Perclose (Closure-S, 6Fr) sutures. We deployed two Perclose devices on 33 femoral sites and three on 8 femoral sites. All the femoral sites were followed with physical examination and CT angiography.
Results: The follow-up periods have ranged from 3 to 22 months (mean 12.5 months). Percutaneous closure with two or three Perclose device was successful in 92.7% (38/41) of the femoral sites without complication such as hematoma, infection, pseudoaneurysm, and arterial thromboses. In 7.3% (3/41) of the femoral sites, arterial complications requiring vascular surgical repair were developed. Conclusions: The novel percutaneous closure technique using two or three Perclose device placed prior to arterial dilatation is useful for hemostasis for stent-graft procedures. The more experience was required and the long-term effect on the femoral arteries was needed to study.
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