Percutaneous suture-mediated closure versus surgical arteriotomy in endovascular aortic aneurysm repair.

ABSTRACT

PURPOSE: To compare percutaneous suture-mediated closure (PSMC) with surgical closure in endovascular aortic aneurysm repair and examine the influence of obesity, sheath size, and vessel calcification on the effectiveness of percutaneous closure. MATERIALS AND METHODS: A total of 445 patients (mean age, 75.9 ± 7.6 years) undergoing aortic aneurysm repair from 2003 to 2010 were retrospectively reviewed. A total of 100 PSMC and 557 surgical closures for arteriotomies with sheath sizes between 12 F and 18 F were compared in terms of failure, complications, and operating room time. Additionally, effects of arterial calcification, body mass index, and sheath size on PSMC were evaluated. RESULTS: Eighty-five percent of PSMCs were successful. Failure was attributed to lack of hemostasis in 11 and difficulty in device positioning in four cases. Complication rate after successful PSMC (9.4%) was significantly less than surgery (19.4%) (P = .02).When failed PSMC cases were considered as complication, the complication rate was not different between the two groups (P = .4). Seroma occurred more after surgical closures (11.4% vs 1.2%; P = .001). Pseudoaneurysm occurred more after PSMC (3.5% vs 0.18%; P = .008).Average PSMC procedure time was less than that of surgical closure (P = .0001). PSMC success rate was 89.7% for < 16-F sheaths and 80.4% for ≥ 16-F sheaths (P = .15). PSMC success was not different between obese and nonobese patients (P = .22). PSMC success in calcified and noncalcified arteries was not different (P = .37). CONCLUSIONS: PSMC is an effective arterial closure method. It is faster and associated with less postprocedure morbidity than surgery. Appropriate technique and meticulous vascular exposure affect PSMC success. Obesity, vascular calcification, and sheath size did not change PSMC outcome in this study.