Fascial Suture To Close Large Percutaneous Sheath Insertion Sites Cheaply And Effectively: Tips And Tricks

Transcription

1 Fascial Suture To Close Large Percutaneous Sheath Insertion Sites Cheaply And Effectively: Tips And Tricks Vascular Center Malmö Sweden Tim Resch, Vascular Center Malmö Skåne University Hospital Sweden

2 None Disclosures

3 J ENDOVASC THER 2012;19: COMMENTARY The Fascia Suture Technique: This Late Bloomer Could Become a Winner CLINICAL INVESTIGATION Robert K. Fisher, MD, FRCS 392 J ENDOVASC THER 2012;19: Regional Vascular Unit, Royal Liverpool and Broadgreen Hospital, Liverpool, UK. Eur J Vasc Endovasc Surg (2011) 41, 346e349 Fascial Closure Following Percutaneous Endovascular Aneurysm Repair G.J. Harrison, D. Thavarajan, J.A. Brennan, S.R. Vallabhaneni, R.G. McWilliams, R.K. Fisher * Complication Rate of the Fascia Closure Technique in Endovascular Aneurysm Repair Sven R. Mathisen, MD, PhD 1 ; Eric Zimmermann, MD 2 ; Ulf Markström, MD 1 ; Kjell Mattsson, MD 2 ; and Thomas Larzon, MD 3 Departments of 1 Vascular Surgery and 2 Radiology, SIHF Hamar, Norway. 3 Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden. Purpose: To assess the rate of complications associated with the fascia closure technique for femoral access sites in which 18-F or 20-F sheaths were introduced during endovascular aneurysm repair (EVAR). Methods: A retrospective analysis was done of 50 consecutive patients (41 men; median age 75 years, range 62 85) who received Excluder stent-grafts in planned percutane EVAR procedures from May 2006 until December The fascia closure techn routinely used for all femoral access sites in which large bore (18-F and 20- were employed. One patient with extremely calcified and narrowed ves to primary cutdown bilaterally after percutaneous access faile patients, 81 femoral access sites were closed with the fasci with smaller 12-F introducers were closed using other te angiography (CTA) was performed within 30 days Results: Of the 81 femoral access sites close patient had persistent bleeding that requ the deep femoral artery (99.0% tec period, 5 patients required add a pseudoaneurysm [92.6% tes had pseudoane ervention. La clusio The Regional Vascular Unit, Royal Liverpool and Broadgreen Hospital, Prescot Street, Liverpool L7 8XP, UK Submitted 15 August 2010; accepted 18 November 2010 Available online 8 December 2010

4 Fascial Closure 90% Technical Success Comparable to other endovascular closures Go directly to main procedure Excellent midterm outcomes Fast Cheap ($10)

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7 Tip 1: Control Puncture

8 Background / Technique 1. Re-insert large sheath (+dilator) awer the complexon of the EVAR/ TEVAR. 2. Incise the skin transversally. Dissect bluntly down to the Cribiform fascia

9 3. Place a lying ma^ress suture, at least 2-0, as a Usuture 4. Make the first throw of a convenxonal knot, Xghten Tip 2: Hangman s knot 5. Withdraw the sheath gently, whilst leaving the guide wire in place. Complete the convenxonal knot

10 Technique 6. Check outcome with wire in place: ü If haemostasis; check the distal perfusion (clinically, DSA or ultrasound) ip 3: Reinsert microcath for DSA

11 Technique 6. Check outcome with the wire in place: ü If haemostasis; check the distal perfusion (clinically DSA or ultrasound) ü If bleeding; re-insert the sheath with dilator: provides temporary hemostasis. Place a new ma^ress suture or perform convenxonal cut down

12 Technique 6. Check outcome: ü If haemostasis; check the distal perfusion (clinically DSA or ultrasound) ü If bleeding; re-insert the sheath with dilator, gives you temporary haemostasis, make a cut down ü If poor distal perfusion; make a DSA, ultrasound or perform cut down

13 Outcomes Technical Success 88-97% Reop for bleeding 1% 1y - <1%

14 Conclusion Techniqually feasible with a high primary technical success rate (>90%) Short learning curve A^enXon to detail Low frequency of clinically significant pseudoaneurysm (1%) Financially excellent ($10 vs $800)