Use of the percutaneous vascular surgery device for closure of femoral access sites during endovascular aneurysm repair: lessons from our experience.

OBJECTIVES: to evaluate the results of our early experience with a percutaneous closure device for aortic aneurysm repair and to identify device related and patient related factors leading to procedure failure. METHODS: eighty-two percutaneous closures in forty-four patients was performed using the 10F Prostar XL Percutaneous Vascular Surgery device during the repair of 1 iliac, 1 thoracic and 42 abdominal aortic aneurysms. RESULTS: successful closure was achieved in 70 access sites (85%) with 12 sites requiring conversion to an open groin incision. The reasons for failure include difficult device introduction due to a tortuous iliac, deflection of needles due to previous scar, femoral artery occlusion and failure of the device to close the arteriotomy. There was one intraoperative death from retroperitoneal haemorrhage and another patient developed a pseudoaneurysm at the cannulation site. CONCLUSIONS: use of the percutaneous closure device requires very careful patient selection. Preoperative radiological assessment of the ilio-femoral vessels is vital to assess for cacification and tortuosity. High device failure rates can be expected from obese patients and those with scarred groins. When difficulty is encountered during the procedure, there should be a low threshold for conversion to an open groin incision. The device and the method of introduction can be further improved to address some of these issues.