Marek Tóth, Juraj Maďarič, Tibor Balázs, Juraj Mikuláš, Daniela Hladíková, Rastislav Bažík, Jana Margitfalviová, Erika Drangová, Terézia Urlandová, Andrej Klepanec, Ivan Vulev
Background: Endovascular abdominal aortic aneurysm repair (EVAR) is an accepted therapeutic strategy. The use of a total percutaneous approach to endovascular repair of aortic pathology is becoming more common and further extends the EVAR indications. The aim of our retrospective analysis was the assessment of safety, technical success, and mid-term results of elective patients scheduled for total percutaneous EVAR implantation (PEVAR). Methods: Sixty-two consecutive patients (male:female 57:5, age 70 ± 9 years, maximal AAA diameter 61 ± 14 mm) underwent elective PEVAR between January 2009 and December 2010. All patients were treated in local anaesthesia by total percutaneous approach via femoral access using the preclose technique with the Prostar XL suture-mediated closure device (Abbott Vascular, US). The immediate technical success of stentgraft implantation and the presence of 30-days and 1-year complication rate were assessed. Results: In all 62 patients (100%) there was an immediate technical success of procedure, with no need of conversion to open surgery. There was one case of prerenal failure (1.6 %), and one case of acute intestinal ischemia (1.6 %) at 30-days follow-up. Repeaed intervention was needed in 8 % (5pts). Event-free survival (mortality/MI/stroke/reintervention/ severe ischemic complication) at 30-days was 89 % (55 / 62 pts). There were 16 cases of the femoral artery pseudoaneurysm per 124 punctures (13 %), all treated by compression or by percutaneous thrombin injection. Anticoagulation therapy emerged as the risk factor for the femoral artery pseudoaneurysm occurrence (OR 5.75; 95 % CI 1.89 - 17.5; p=0.003). At one-year follow-up period the mortality increased to 9.6 % (6 pts), overall event-free survival was 81 %. Conclusion: The policy of total percutaneous endovascular abdominal aortic aneurysm repair is linked with low mortality and acceptable complication rate in patients scheduled for EVAR implantation. Anticoagulation therapy is the risk factor for the femoral artery pseudoaneurysm occurrence after PEVAR. The correct indication, technical realization, and adequate periprocedural management are essential for further reduction of adverse events after PEVAR.