Utilization of percutaneous closure devices for large bore arterial access in patients with genetic aortopathy does not result in increased rates of access site complications

Percutaneous closure devices for arterial sheaths of sufficient caliber to deliver aortic endografts have a published success rate of 90% to 95%. Despite this, they are frequently avoided in patients with genetic aortopathy due to concern for high failure rates and increased complications in the setting of compromised tissue integrity. This study aims to compare rates of access site complications after large bore percutaneous access among patients with and without confirmed genetic aortopathy. All patients undergoing endovascular aortic procedures requiring large bore (≥9F) femoral sheath access between 2019 and 2023 were identified. The specific mutation, demographics, comorbidities, and operative details including maximum sheath size were recorded. Outcomes including unplanned femoral cutdown, access site complications, and reinterventions were evaluated. These factors were then compared between patients with and without a laboratory-confirmed mutation associated with genetic aortopathy. A supplemental analysis was then performed on all patients with genetic aortopathy from 2014 to 2023. Among the 404 patients identified, 33 (8%) had confirmed genetic aortopathy. Among these, 7 patients (21%) had Marfan syndrome, 7 (21%) had Loeys-Dietz syndrome, and 3 (9%) had vascular Ehlers-Danlos. Also represented were ACTA2, PRKG1, FOXE3, and LOX mutations. The genetic aortopathy group was significantly younger (median genetic aortopathy: median 52 years; nongenetic aortopathy: 71 years; P < .001). Thoracic endovascular aortic repair was most frequent in the genetic aortopathy group (52%), followed by zone II arch replacement with frozen elephant trunk (21%); the most frequent operation among the nongenetic aortopathy group was fenestrated/branched endovascular aortic repair (43%), followed by thoracic endovascular aortic repair (25%). Both groups had a median sheath size of 20F; the patients with genetic aortopathy had higher rates of both prior open (genetic aortopathy: 27%; nongenetic aortopathy: 12%; P = .015) and prior percutaneous ipsilateral access (genetic aortopathy: 58%; nongenetic aortopathy: 39%; P = .041). Rates of unplanned cutdowns (genetic aortopathy: 0%; nongenetic aortopathy: 6%) and access site complications (genetic aortopathy: 0%; nongenetic aortopathy: 8%) did not significantly differ between groups (P = .160 and P = .096, respectively). In supplementary analysis, there was one patient with genetic aortopathy who required unplanned cutdown, yie