The Preclose Technique Augmented With Angio-Seal Device Studied in Percutaneous EVAR

September 9, 2015—Rafiuddin Patel, MD, et al reported on the experience of selectively augmenting the preclose technique for percutaneous endovascular aneurysm repair (PEVAR) with an Angio-Seal collagen-based closure device (St. Jude Medical, Inc.) as a hemostatic adjunct in cases of significant bleeding after tensioning the sutures of the suture-mediated closure devices. The investigators published their findings in CardioVascular and Interventional Radiology (2015;38:821–826).

The investigators prospectively analyzed collected data for PEVAR patients at their institute, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, in Headington, United Kingdom. 

Outcomes included technical success and access site complications. A logistic regression model was used to analyze the effects of sheath size, common femoral artery (CFA) features, and stent graft type on primary failure of the preclose technique necessitating augmentation and the development of complications.

As summarized in CardioVascular and Interventional Radiology, the investigators attempted PEVAR via 122 CFA access sites with a median sheath size of 18-F (range, 12 F to 28 F). Primary success of the preclose technique was 75.4% (92/122). Angio-Seal augmentation was utilized as an adjunct to the preclose technique in 20.5% (25/122). The overall PEVAR success rate was 95.1% (116/122). 

The investigators found that there was a statistically significant relationship (P = .0093) between depth of CFA and primary failure of preclose technique. CFA diameter, calcification, type of stent graft, and sheath size did not have significant effects on primary preclose technique failure. Overall, 4.9% (6/122) of procedures required surgical conversion; otherwise, there were no major complications.

Augmentation with an Angio-Seal device is a safe and effective adjunct to increase the success rate of the preclose technique in PEVAR, concluded the investigators in CardioVascular and Interventional Radiology.