Percutaneous femoral artery access is often employed for infrarenal Endovascular Aneurysm Repair (EVAR) given its safety, decreased length of stay and improved perioperative quality of life compared to open femoral artery exposure. However, evaluation of percutaneous femoral artery outcomes for Fenestrated and Branched EVAR (F/BEVAR) is limited. We sought to compare outcomes of a percutaneous-first femoral artery access strategy with an open-first femoral artery access strategy for F/BEVAR. Endovascular Aortic Repair (EVAR) has revolutionized the field of aortic surgery. Historically, open surgical repair necessitated a prolonged inpatient hospitalization, admission to the critical care unit, and posed significant morbidity and mortality. The introduction of EVAR has resulted in favorable early morbidity and mortality for the repair of Abdominal Aortic Aneurysms (AAA).Moreover, the treatment of complex paravisceral and thoracoabdominal aortic aneurysms with Fenestrated and Branched EVAR (F/BEVAR) has seen a parallel, if not more pronounced, improvement in perioperative outcomes when compared with open surgical repair.A percutaneous approach to infrarenal EVAR offers patients decreased time to ambulation, decreased pain, and fewer wound complications. Additionally, percutaneous EVAR has also been shown to reduce operative time, decrease length of stay, and offer a high rate of technical success. ogether, these facets have made percutaneous EVAR an attractive alternative to open surgical femoral artery exposure for the delivery of the endograft. It is no surprise that there has been increasing adoption of this technique nationwide.

All patients undergoing fenestrated or branched endovascular aneurysm repair (>1 fenestration and/or branch) for the repair of an aortic arch aneurysm, thoracoabdominal aortic aneurysm, pararenal abdominal aortic aneurysm, or juxtarenal abdominal aortic aneurysm were included in the present study. All patients were previously deemed too-high-risk for open repair of their aneurysm, as determined by the surgeon and study team. Procedures were planned based on high-resolution Computed Tomography Angiography (CTA). Each study was reviewed on a three-dimensional workstation. Centerline-reconstruction was then utilized to obtain orthogonal measurements (TeraRecon, foster city, CA) to determine candidacy for stent-graft repair. Custom-made, commercially manufactured fenestrated and/or branched devices were utilized. For patients with anatomy suitable for a commercially approved fenestrated or branched device available to the study team (i.e. Zenith Fenestrated 9ZFEN)), or off-the-shelf trial device (i.e., Cook p-Branch), the corresponding commercially manufactured device was chosen and the patient was not included in the PS-IDE trial. For patients whose aneurysms were deemed too high risk to wait the required manufacturing time (i.e. symptomatic or ruptured aneurysms) and whose anatomies were not appropriate for an off-the-shelf device (i.e., Cook t-Branch), a Physician-Modified Endograft (PMEG) was used.All patients undergoing F/BEVAR for complex aneurysms during the study period were eligible for inclusion. Prior to August 2019, all patients who underwent endovascular repair of complex aneurysms did so via open surgical exposure of the common femoral arteries. Beginning August 1st, 2019, we adopted a percutaneous-first approach to femoral artery access for all patients undergoing F/BEVAR. The surgeon would attempt percutaneous bilateral femoral artery access. If percutaneous access or femoral artery pre-closure could not be performed, the surgery would proceed via unilateral or bilateral femoral artery open surgical exposure. In the case of conversion to either unilateral or bilateral femoral artery open surgical exposure, the patient was considered a conversion to open.

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American Journal of Phytomedicine and Clinical Therapeutics
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