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Objective: Previous review of 30-day outcomes of percutaneous Endovascular Aneurysm Repair (pEVAR) using the ACS-NSQIP data from the years 2005-2008 revealed decreased operative times, but increased composite morbidity and similar mortality and length of stay compared to standard EVAR via open femoral exposure. In contrast, the recent FDA pEVAR trial conducted from 2010-2012 demonstrated non-inferiority of pEVAR to standard EVAR in trained operators using the Perclose ProGlide. The purpose of this study was to examine contemporary real world experience with pEVAR.
Methods: We queried the ACS-NSQIP public use file from 2012. This data specifically listed the type of access as documented in the operative note, including “bilateral groin cutdown”, “attempted percutaneous access converted to open cutdown” and “percutaneous bilateral.” Based on intention to treat, the “attempted” and “successful” percutaneous access cases were combined to the pEVAR group. Cases of unilateral cutdown with contralateral percutaneous were excluded, as were non-elective cases. We then compared preoperative and perioperative data between pEVAR and standard EVAR, as well as 30-day outcomes and length of hospital stay.
Results: Specific access codes were documented for 1,413 EVAR procedures: 408 percutaneous (including 14 conversions) and 1005 via groin cutdown. Compared to the pEVAR group, the standard EVAR group included a higher percentage of patients that were ASA class IV or V (21% vs 16%, p=0.02) or Obese BMI>30 (33% vs 28%, p=0.04). Outcomes are summarized in Table 1. Of note, the decreased wound complication rate for pEVAR lost statistical significance when corrected for obesity.
Conclusions: Contemporary data suggests that pEVAR continues to be associated with decreased operative times, but no longer is associated with increased morbidity compared to standard EVAR. In addition, Length of Stay was decreased in the pEVAR group. However, the results may have been influenced by selection biases favoring pEVAR.
Table 1

Variable	Percutaneous	Groin Cutdown	P-Value
No. of Procedures	408	1005
Median Duration of Operation, min. (IQR)	120 (96 – 159)	138 (108 – 180)	< .001
Median Length of Hospital Stay, days (IQR)	1 (1 – 3)	2 (1 – 3)	.005
% 30-day mortality	1.8	1.3	.484
% 30-day morbidity (any of the following)	20.8	22.7	.427
%Transfused w/in 72 h. of operation,	10.1	11.4	.482
% Return to the OR	2.9	4.2	.251
% Readmitted w/in 30 days	8.6	8.9	.922
% Cardiac or Respiratory Failure	3.3	3.1	.876
% Graft Failure w/in 30 days	0	0	1.000
% Surgical Site Infection or Dehiscence	0.7	2.3	.024
% Renal Insufficiency or Failure	2.6	2.5	.860
% Pneumonia	0.9	0.9	1.000
% Sepsis/Septic Shock	0.7	1.0	.773
% Treated DVT/Pulmonary Embolism	1.1	0.9	.781