Totally percutaneous aortic aneurysm repair: methods and outcomes using the fully integrated IntuiTrak endovascular system

Abstract

Aim: A totally percutaneous approach to endovascular abdominal aortic aneurysm repair (PEVAR) has been shown in multiple reports to be feasible, but carries attendant risks that appear to increase with increasing sheath size. We report our methods and sequential PEVAR case experience using a new delivery system having an integrated 19Fr introducer sheath for treatment of patients with aortic necks up to 32 mm in diameter.

Methods: A single institution, prospective, controlled evaluation was conducted in 57 consecutive patients with abdominal aortic aneurysm who underwent PEVAR between December 2008 and April 2010. All patients have been followed for at least 30 days.

Results: Patients presented at a mean age of 74 years with median AAA diameter of 5.4 cm preprocedurally. Calcified/tortuous access vessels were identified in 98% of patients. All PEVAR procedures with adjunctive "pre-close" use of the Prostar XL closure device were performed in a hybrid endovascular suite with patients maintained under conscious sedation and local anesthesia. The anatomically-fixed bifurcated stent graft and aortic/limb extensions as needed were implanted via the 19 Fr indwelling introducer sheath with minimal blood loss (79 mL). Technical success was 98%, with one conversion to open repair attributable to very small diameter (4 mm) access vessels. Cumulatively, major access-related complications were observed in five patients (8.8%) within 30 days.

Conclusion: PEVAR using the IntuiTrak System with 19Fr introducer sheath with vessel closure facilitated by the Prostar XL device is feasible, even in patients with challenging access anatomy. Further evaluation in a prospective, multicenter, randomized trial is warranted.