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• W4236039088 abstract "Arterial access for endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) has evolved from open exposure to percutaneous techniques. Effectiveness in the use of access methods between EVAR and TEVAR requires further exploration. The Gore Global Registry for Endovascular Aortic Treatment (GREAT) provides relevant data for comparison between open and percutaneous approaches for EVAR and TEVAR. This was a retrospective review of patient data from the GREAT registry (ClinicalTrials.gov identifier: NCT01658787). The primary outcome was successful vascular access, access site complications, and postoperative length of stay (LOS). Patients were categorized by EVAR and TEVAR procedures stratified by percutaneous only, cutdown only, or combined vascular access techniques for a total of six groups. Standard methodology was used to perform single-variable and multivariable analysis of covariates including LOS, geographic location of procedure, access site complications, and access sheath size. Of 4939 patients, 3926 (79.5%) underwent EVAR and 1013 (20.5%) underwent TEVAR; access methods were 2048 (41.5%) percutaneous only, 2480 (50.2%) cutdown only, and 411 (4.3%) combined techniques. Rates of procedures and access techniques differed significantly on the basis of geographic location. Australia/New Zealand and the United States used percutaneous access in the majority of cases, whereas Brazil and Europe used open access (Table I). Lower rates of access site complications were associated with percutaneous-only access compared with cutdown-only and combined techniques (P = .03; Table II). For EVAR, LOS with percutaneous-only access was shorter compared with cutdown-only (−2.0 days; P < .0001) and combined techniques (−1.4 days; P < .0001). For TEVAR, LOS with percutaneous-only access was shorter compared with cutdown-only access (−0.94 days; P < .0001). LOS was significantly greater with larger sheaths compared with small sheaths (5.38 days vs 3.54 days; P < .002). LOS was significantly lower in the U.S. region (3.5 days) opposed to the Australia/New Zealand, Brazil, and Europe regions (8.2 days, 7.3 days, and 7.1 days, respectively; P < .05). Percutaneous-only access in endovascular aortic surgery can be performed with acceptable outcomes and is associated with decreased access site complication rates. This analysis demonstrates that percutaneous-only access is safe, has a low complication rate, and has a lower LOS compared with open access or combined access techniques. We propose that percutaneous access be considered a preferred method of vascular access for endovascular aortic interventions.Table IAccess methods and sheath sizes by regionAustralia/New ZealandBrazilEuropeUnited StatesTotalPercutaneous only163 (85.34)34 (8.50)528 (29.22)1323 (52.07)2048 (41.47)Cutdown only11 (5.76)327 (81.75)1171 (64.80)971 (38.21)2480 (50.2)Percutaneous and cutdown17 (8.90)39 (9.75)108 (5.98)247 (9.72)411 (8.32)Small sheath size (<16F)2 (1.05)4 (1.00)39 (2.16)60 (2.36)105 (2.1)Large sheath size (>18F)189 (98.95)396 (99.00)1768 (97.84)2481 (97.64)4834 (97.9)Total191400180725414939Values are reported as number (%). Open table in a new tab Table IIPrimary end point in combined endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) groups and percutaneous-only and cutdown-only groupsMethodPrimary end pointNoYesTotalEVAR only3862 (98.4)64 (1.6)3926TEVAR only988 (97.5)25 (2.5)1013Percutaneous onlya2022 (98.7)26 (1.3)2048Cutdown onlya2427 (97.9)53 (2.1)2480Total4449 (98.3)79 (1.7)4528Values are reported as number (%).aP < .05. Open table in a new tab" @default.
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• W4236039088 date "2019-11-01" @default.
• W4236039088 modified "2023-09-28" @default.
• W4236039088 title "AAA 14. Outcome of Open Versus Percutaneous Access for Patients Enrolled in the GREAT Registry" @default.
• W4236039088 doi "https://doi.org/10.1016/j.jvs.2019.08.070" @default.
• W4236039088 hasPublicationYear "2019" @default.
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