Abstract
Totally percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) using suture-mediated
closure devices (SMCDs) has several well-established advantages over standard open
femoral exposure as a direct consequence of being less invasive and having shorter
times to hemostasis and procedure completion. The first multicenter randomized controlled
trial designed to assess the safety and efficacy of PEVAR and to compare percutaneous
access with standard open femoral exposure was recently published (the PEVAR trial).
The PEVAR trial demonstrated that percutaneous endografting is safe, effective, and
noninferior to standard open femoral exposure among trained operators. The study reaffirmed
the results of several recent single center and nonrandomized studies, demonstrating
that percutaneous access facilitated shorter procedures, shorter times to secure hemostasis,
and improved quality of life for patients. As PEVAR has gained popularity among patients
and physicians, refinements to the technique and patient selection process have been
made. There has been growing interest in treating patients with anatomical characteristics
previously thought to be unsuitable for PEVAR, such as common femoral artery (CFA)
calcifications, scarred groins, small CFA diameter, and high patient body mass index
(BMI). However, observance of strict procedural technique and consideration for patient
selection criteria remain paramount in achieving acceptable technical success rates
with PEVAR.
Keywords
preclose - PEVAR - ProGlide - interventional radiology
