Jason Zakko, Salvatore T. Scali, Charles T. Klodell, Phillip J. Hess, Thomas M. Beaver, Tomas D. Martin, Thomas S. Huber, Adam W. Beck, Robert J. Feezor
Surgery, University of Florida, Gainesville, FL.
OBJECTIVES: There are limited data describing the "Preclose" technique in TEVAR(P-TEVAR), particularly in obese patients (BMI≥30kg/m2), in whom this technique is thought to be contraindicated. We describe our experience with P-TEVAR and compare outcomes in obese and non-obese patients.
METHODS: All patients undergoing TEVAR at a single institution from 2005-2011 were reviewed; patients undergoing P-TEVAR were identified and stratified by BMI. Technical success was defined as the ability to achieve hemostasis and maintain limb perfusion without the need for surgical repair of the vessel.
RESULTS: Of 536 TEVARs, 359 (67%) P-TEVAR procedures were completed. For the entire P-TEVAR cohort, mean age±SD was 62.9±15.7 years with BMI of 27.5±5.4. Mean sheath diameter, largest TEVAR stent diameter, and number of Perclose deployments were 22.4±2.5F, 34.6±7.8mm and 2.1±0.4, respectively. Mean access vessel inner diameter was 8.0±2.0mm with average depth of 35.6±17.5mm. Adjunctive iliac stents were used in 9.4% (n=34). Overall Preclose success rate was 92.6%:92.2% for non-obese patients and 93.8% for obese patients (p=0.57). Three patients required subsequent operations for access complications: 2 obese patients (2%) and 1 non-obese patient (0.3%). By univariate analysis, higher age, increased sheath size, larger aortic stent diameter, use of more than 2 Perclose devices, need for iliac stents and higher femoral artery calcium score were associated with failure. Independent predictors of failure were adjunctive iliac stent (OR8.9;95%CI 2.9-27.4, p=.003), >2 Perclose devices (6.7;2.2-20.2, p=0.001), and decreased access vessel diameter (1.5;1.1-2, p=0.008).
CONCLUSIONS: Percutaneous endovascular repair of thoracic aortic pathology is safe. Obesity does not appear to be a contraindication for the "Preclose" technique. Patients predicted to need adjunctive stenting or possessing smaller access vessel diameters with greater degree of calcification are at highest risk of failure and selective use of this technique is recommended.
AUTHOR DISCLOSURES: T. M. Beaver: Nothing to disclose; A. W. Beck: Cook Medical, Research grants; Medtronic, Research grants; Medtronic, Consulting fees or other remuneration (payment); Cook Medical, Consulting fees or other remuneration (payment); R. J. Feezor: Cook Medical, Research grants; Medtronic, Research grants; Cook Medical, Consulting fees or other remuneration (payment); P. J. Hess: Nothing to disclose; T. S. Huber: Nothing to disclose; C. T. Klodell: Nothing to disclose; T. D. Martin: Nothing to disclose; S. T. Scali: Nothing to disclose; J. Zakko: Nothing to disclose.
Posted April 2013