Bioabsorbable extravascular closure following failed suture mediated closure during PEVAR; an alternative to femoral cutdown
Valerie Takyi, MD, Pegge Halandras, MD, Carlos Bechara, MD, Bernadette Aulivola, MD, Paul Crisostomo, MD.
Loyola University Medical Center, Maywood, IL, USA.
OBJECTIVES: Percutaneous femoral vascular access is frequently used for endovascular aortic aneurysm repair (EVAR) with access site complication rates ranging from 2-16%. We present two patients in which a bioabsorbable extravascular closure device was used as an adjunct in the face of failed suture mediated closure (SMC) devices following totally percutaneous endovascular aneurysm repair (PEVAR).
METHODS: A 68-year-old male with a history of EVAR x2 with bilateral femoral cutdowns presented with rapidly expanding left common and internal iliac artery aneurysms. He underwent PEVAR with ultrasound guided access of the right brachial and bilateral common femoral arteries. An 18 French sheath was used in the ipsilateral femoral artery for delivery. We used two SMC devices (ProGlide) in a preclose technique. At conclusion, ongoing bleeding persisted despite closure of the prior sutures. Three additional attempts at SMC also failed. Finally, a bioabsorbable extravascular closure device (MYNXGRIP, 6F) was used as an adjunct with immediate positive effect.
The second patient is a 47-year-old male who presented with complicated type B aortic dissection requiring emergent operative intervention. The preclose technique was not utilized. He underwent percutaneous TEVAR through a 22 French sheath in the left groin. Two SMC devices (ProGlide) were used at conclusion. Despite deployment and reversal of heparin, ongoing bleeding persisted. Additional SMC device failed to advance over the wire despite numerous attempts. Instead, a small 5F sheath and bioabsorbable closure device (MYNXGRIP) were utilized with immediate positive effect.
RESULTS: Neither patient demonstrated ongoing bleeding intraoperatively after bioabsorbable closure device adjunct. No groin hematoma developed during the remainder of their hospital stay. At 1 month postoperative follow up, no access site complications were identified.
CONCLUSIONS: Bioabsorbable closure device following failed SMC deployment is effective and may serve as an alternative to femoral cutdown after PEVAR.
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