Abstract 16209: Safety and Efficacy of Percutaneous Groin Access Closure vs. Surgical Cutdown for Thoracic Endovascular Aortic Repair and Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Analysis
IntroductionThoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve replacement (TAVR) necessitate large-bore arterial access for stent/valve delivery. With improvement of device delivery technology, percutaneous access has become the standard. This may be associated with fewer co...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A16209-A16209 |
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| container_title | Circulation (New York, N.Y.) |
| container_volume | 140 |
| creator | Carroll, Adam M Reece, T B Ghincea, Christian V Ikeno, Yuki Roth, Kaitlin Wiktor, Dominik M Messenger, John C Carroll, John D Cleveland, Joseph C Fullerton, David A Aftab, Muhammad |
| description | IntroductionThoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve replacement (TAVR) necessitate large-bore arterial access for stent/valve delivery. With improvement of device delivery technology, percutaneous access has become the standard. This may be associated with fewer complications, though literature is conflicting. The purpose of this study was to compare outcomes of open vs. percutaneous large bore arterial access at a single institution.HypothesisPercutaneous arterial access for device delivery is associated with fewer complications than surgical cutdown.MethodsIncluded were 746 patients who underwent TEVAR or TAVR between over 13 years. Only groins accessed for delivery sheath were included for analysis, with size ranging from 12-28 French (Fr.). Complications assessed included bleeding (hematoma, perforation, rupture, pseudoaneurysm), infection, seroma, dissection, and embolization.ResultsPatient characteristics are summarized in Table 1. Sheath diameter was predictive of conversion to open with a median of 20Fr. (IQR 16-22) vs. 16 Fr. (IQR 14-20) in cases that were completed percutaneously (p |
| doi_str_mv | 10.1161/circ.140.suppl_1.16209 |
| format | Article |
| fullrecord | <record><control><sourceid>wolterskluwer</sourceid><recordid>TN_cdi_wolterskluwer_health_00003017-201911191-03614</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>00003017-201911191-03614</sourcerecordid><originalsourceid>FETCH-wolterskluwer_health_00003017-201911191-036143</originalsourceid><addsrcrecordid>eNqdkE1OwzAQhS0EEuXnCmgukGAnaap0F0UFllVbsa2MO2kMxo48dqvelONgKsQBWIxG78379KRh7EHwXIhaPCrtVS4qnlMcR7MVuagL3lywiZgWVVZNy-aSTTjnTTYri-Ka3RC9J1mXs-mEfbVvFLxUAc7UHNayx3ACaXew6HutpDqB62GJXsUgLbpI8OydttAqhUTQGUfRIxwoh3X0-4QY6GLYuaOF3nnYDC4VaAULu3MHSSoa6aF1PiRvhaPU_ly38dKSkmHAgH_3V2kO-JMyUuEn2jCHFtba7g1mXZIpucLgHY2ogk7R1kpzIk137KqXhvD-d9-y6mmx6V6yozOJog8Tj-i3A0oThm36By-5mGUFF40QaTJe1qIq_4l9A_2EgRU</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Abstract 16209: Safety and Efficacy of Percutaneous Groin Access Closure vs. Surgical Cutdown for Thoracic Endovascular Aortic Repair and Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Analysis</title><source>American Heart Association Journals</source><source>Journals@Ovid Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Carroll, Adam M ; Reece, T B ; Ghincea, Christian V ; Ikeno, Yuki ; Roth, Kaitlin ; Wiktor, Dominik M ; Messenger, John C ; Carroll, John D ; Cleveland, Joseph C ; Fullerton, David A ; Aftab, Muhammad</creator><creatorcontrib>Carroll, Adam M ; Reece, T B ; Ghincea, Christian V ; Ikeno, Yuki ; Roth, Kaitlin ; Wiktor, Dominik M ; Messenger, John C ; Carroll, John D ; Cleveland, Joseph C ; Fullerton, David A ; Aftab, Muhammad</creatorcontrib><description>IntroductionThoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve replacement (TAVR) necessitate large-bore arterial access for stent/valve delivery. With improvement of device delivery technology, percutaneous access has become the standard. This may be associated with fewer complications, though literature is conflicting. The purpose of this study was to compare outcomes of open vs. percutaneous large bore arterial access at a single institution.HypothesisPercutaneous arterial access for device delivery is associated with fewer complications than surgical cutdown.MethodsIncluded were 746 patients who underwent TEVAR or TAVR between over 13 years. Only groins accessed for delivery sheath were included for analysis, with size ranging from 12-28 French (Fr.). Complications assessed included bleeding (hematoma, perforation, rupture, pseudoaneurysm), infection, seroma, dissection, and embolization.ResultsPatient characteristics are summarized in Table 1. Sheath diameter was predictive of conversion to open with a median of 20Fr. (IQR 16-22) vs. 16 Fr. (IQR 14-20) in cases that were completed percutaneously (p<=0.004). There was a significantly higher rate of total complications (24.6% vs. 9.4%; p=0.001), infection, and bleeding in open compared to percutaneous cases. No significant differences were observed in seroma, dissection, and embolization.Total complications and infection remained significant after propensity matching. Delivery sites were successfully closed using a median of 2 percutaneous closure devices.ConclusionsPercutaneous access is associated with significantly lower rates of total complications, infection, and bleeding compared to surgical cutdown. Delivery sheath size was predictive of conversion to open, but the overall incidence was low. Large-bore arterial access closure can be safely achieved using a percutaneous strategy, with fewer complications than the open approach.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/circ.140.suppl_1.16209</identifier><language>eng</language><publisher>by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><ispartof>Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A16209-A16209</ispartof><rights>2019 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids></links><search><creatorcontrib>Carroll, Adam M</creatorcontrib><creatorcontrib>Reece, T B</creatorcontrib><creatorcontrib>Ghincea, Christian V</creatorcontrib><creatorcontrib>Ikeno, Yuki</creatorcontrib><creatorcontrib>Roth, Kaitlin</creatorcontrib><creatorcontrib>Wiktor, Dominik M</creatorcontrib><creatorcontrib>Messenger, John C</creatorcontrib><creatorcontrib>Carroll, John D</creatorcontrib><creatorcontrib>Cleveland, Joseph C</creatorcontrib><creatorcontrib>Fullerton, David A</creatorcontrib><creatorcontrib>Aftab, Muhammad</creatorcontrib><title>Abstract 16209: Safety and Efficacy of Percutaneous Groin Access Closure vs. Surgical Cutdown for Thoracic Endovascular Aortic Repair and Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Analysis</title><title>Circulation (New York, N.Y.)</title><description>IntroductionThoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve replacement (TAVR) necessitate large-bore arterial access for stent/valve delivery. With improvement of device delivery technology, percutaneous access has become the standard. This may be associated with fewer complications, though literature is conflicting. The purpose of this study was to compare outcomes of open vs. percutaneous large bore arterial access at a single institution.HypothesisPercutaneous arterial access for device delivery is associated with fewer complications than surgical cutdown.MethodsIncluded were 746 patients who underwent TEVAR or TAVR between over 13 years. Only groins accessed for delivery sheath were included for analysis, with size ranging from 12-28 French (Fr.). Complications assessed included bleeding (hematoma, perforation, rupture, pseudoaneurysm), infection, seroma, dissection, and embolization.ResultsPatient characteristics are summarized in Table 1. Sheath diameter was predictive of conversion to open with a median of 20Fr. (IQR 16-22) vs. 16 Fr. (IQR 14-20) in cases that were completed percutaneously (p<=0.004). There was a significantly higher rate of total complications (24.6% vs. 9.4%; p=0.001), infection, and bleeding in open compared to percutaneous cases. No significant differences were observed in seroma, dissection, and embolization.Total complications and infection remained significant after propensity matching. Delivery sites were successfully closed using a median of 2 percutaneous closure devices.ConclusionsPercutaneous access is associated with significantly lower rates of total complications, infection, and bleeding compared to surgical cutdown. Delivery sheath size was predictive of conversion to open, but the overall incidence was low. Large-bore arterial access closure can be safely achieved using a percutaneous strategy, with fewer complications than the open approach.</description><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqdkE1OwzAQhS0EEuXnCmgukGAnaap0F0UFllVbsa2MO2kMxo48dqvelONgKsQBWIxG78379KRh7EHwXIhaPCrtVS4qnlMcR7MVuagL3lywiZgWVVZNy-aSTTjnTTYri-Ka3RC9J1mXs-mEfbVvFLxUAc7UHNayx3ACaXew6HutpDqB62GJXsUgLbpI8OydttAqhUTQGUfRIxwoh3X0-4QY6GLYuaOF3nnYDC4VaAULu3MHSSoa6aF1PiRvhaPU_ly38dKSkmHAgH_3V2kO-JMyUuEn2jCHFtba7g1mXZIpucLgHY2ogk7R1kpzIk137KqXhvD-d9-y6mmx6V6yozOJog8Tj-i3A0oThm36By-5mGUFF40QaTJe1qIq_4l9A_2EgRU</recordid><startdate>20191119</startdate><enddate>20191119</enddate><creator>Carroll, Adam M</creator><creator>Reece, T B</creator><creator>Ghincea, Christian V</creator><creator>Ikeno, Yuki</creator><creator>Roth, Kaitlin</creator><creator>Wiktor, Dominik M</creator><creator>Messenger, John C</creator><creator>Carroll, John D</creator><creator>Cleveland, Joseph C</creator><creator>Fullerton, David A</creator><creator>Aftab, Muhammad</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope/></search><sort><creationdate>20191119</creationdate><title>Abstract 16209: Safety and Efficacy of Percutaneous Groin Access Closure vs. Surgical Cutdown for Thoracic Endovascular Aortic Repair and Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Analysis</title><author>Carroll, Adam M ; Reece, T B ; Ghincea, Christian V ; Ikeno, Yuki ; Roth, Kaitlin ; Wiktor, Dominik M ; Messenger, John C ; Carroll, John D ; Cleveland, Joseph C ; Fullerton, David A ; Aftab, Muhammad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-wolterskluwer_health_00003017-201911191-036143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Carroll, Adam M</creatorcontrib><creatorcontrib>Reece, T B</creatorcontrib><creatorcontrib>Ghincea, Christian V</creatorcontrib><creatorcontrib>Ikeno, Yuki</creatorcontrib><creatorcontrib>Roth, Kaitlin</creatorcontrib><creatorcontrib>Wiktor, Dominik M</creatorcontrib><creatorcontrib>Messenger, John C</creatorcontrib><creatorcontrib>Carroll, John D</creatorcontrib><creatorcontrib>Cleveland, Joseph C</creatorcontrib><creatorcontrib>Fullerton, David A</creatorcontrib><creatorcontrib>Aftab, Muhammad</creatorcontrib><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carroll, Adam M</au><au>Reece, T B</au><au>Ghincea, Christian V</au><au>Ikeno, Yuki</au><au>Roth, Kaitlin</au><au>Wiktor, Dominik M</au><au>Messenger, John C</au><au>Carroll, John D</au><au>Cleveland, Joseph C</au><au>Fullerton, David A</au><au>Aftab, Muhammad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Abstract 16209: Safety and Efficacy of Percutaneous Groin Access Closure vs. Surgical Cutdown for Thoracic Endovascular Aortic Repair and Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Analysis</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><date>2019-11-19</date><risdate>2019</risdate><volume>140</volume><issue>Suppl_1 Suppl 1</issue><spage>A16209</spage><epage>A16209</epage><pages>A16209-A16209</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>IntroductionThoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve replacement (TAVR) necessitate large-bore arterial access for stent/valve delivery. With improvement of device delivery technology, percutaneous access has become the standard. This may be associated with fewer complications, though literature is conflicting. The purpose of this study was to compare outcomes of open vs. percutaneous large bore arterial access at a single institution.HypothesisPercutaneous arterial access for device delivery is associated with fewer complications than surgical cutdown.MethodsIncluded were 746 patients who underwent TEVAR or TAVR between over 13 years. Only groins accessed for delivery sheath were included for analysis, with size ranging from 12-28 French (Fr.). Complications assessed included bleeding (hematoma, perforation, rupture, pseudoaneurysm), infection, seroma, dissection, and embolization.ResultsPatient characteristics are summarized in Table 1. Sheath diameter was predictive of conversion to open with a median of 20Fr. (IQR 16-22) vs. 16 Fr. (IQR 14-20) in cases that were completed percutaneously (p<=0.004). There was a significantly higher rate of total complications (24.6% vs. 9.4%; p=0.001), infection, and bleeding in open compared to percutaneous cases. No significant differences were observed in seroma, dissection, and embolization.Total complications and infection remained significant after propensity matching. Delivery sites were successfully closed using a median of 2 percutaneous closure devices.ConclusionsPercutaneous access is associated with significantly lower rates of total complications, infection, and bleeding compared to surgical cutdown. Delivery sheath size was predictive of conversion to open, but the overall incidence was low. Large-bore arterial access closure can be safely achieved using a percutaneous strategy, with fewer complications than the open approach.</abstract><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><doi>10.1161/circ.140.suppl_1.16209</doi></addata></record> |
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| source | American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| title | Abstract 16209: Safety and Efficacy of Percutaneous Groin Access Closure vs. Surgical Cutdown for Thoracic Endovascular Aortic Repair and Transcatheter Aortic Valve Replacement: A Single-Center Retrospective Analysis |
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