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Chirurgia 2022 December;35(6):349-54

DOI: 10.23736/S0394-9508.22.05381-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Ankle-Brachial Index evaluation in totally percutaneous approach vs. femoral artery cutdown for endovascular aortic repair of abdominal aortic aneurysms

Umberto M. BRACALE 1, Antonio PELUSO 1, Marco PANAGROSSO 1, Fabrizio CECERE 1, Luca DEL GUERCIO 1, Roberto MINICI 2, Nicola GIANNOTTA 3, 4, Nicola IELAPI 4, 5, Noemi LICASTRO 1, 3, 4, Giuseppe F. SERRAINO 6, Pasquale MASTROROBERTO 6, Michele ANDREUCCI 7, Raffaele SERRA 3, 4

1 Unit of Vascular Surgery, Department of Public Health, University of Naples Federico II, Naples, Italy; 2 Department of Radiology, Pugliese-Ciaccio Hospital, Catanzaro, Italy; 3 International Research and Educational Program in Clinical and Experimental Biotechnology, Interuniversity Center of Phlebolymphology (CIFL), The Magna Græcia University of Catanzaro, Catanzaro, Italy; 4 Department of Medical and Surgical Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy; 5 Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy; 6 Department of Experimental and Clinical Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy; 7 Department of Health Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy



BACKGROUND: Endovascular abdominal aortic aneurysm repair (EVAR) should be considered as the preferred treatment modality for infrarenal abdominal aortic aneurysm for patients with suitable anatomy and reasonable life expectancy. Surgical cut-down of both femoral arteries during EVAR procedure is associated with an increased risk of local complications. Therefore, nowadays most EVAR procedures are performed with a totally percutaneous approach.
METHODS: Based on the evaluation of the Ankle Brachial Index (ABI) variation, the purpose of this study was to evaluate possible hemodynamic alterations on arterial perfusion of the lower limbs in two different types of access for EVAR procedures: totally percutaneous (p-EVAR) and EVAR with surgical access (s-EVAR).
RESULTS: Our study considered 38 patients (36 men, mean age of 70.6±8.3 years) subjected to EVAR procedure between January 1, 2019 and December 31, 2020. The variation in pre- and postoperative ABI values (∆ ABI) and procedure-related complications rate were considered as primary outcomes. The p-EVAR group consisted of 27 patients (92.6% males, mean age of 72.3±8.6) while the s-EVAR group was composed by 11 patients (100% males, mean age of 69±8.1). The follow-up period was ranged from a minimum of 6 to a maximum of 12.3 months. In particular, the pre- and postoperative Δ ABI and the procedure-related complications rate, both considered as primary outcomes, did not show any significant difference between two groups, and in both groups, the technical success rate was 100%.
CONCLUSIONS: Pre- and postoperative Δ ABI and the procedure-related complications rate, did not show any significant difference between two groups. We can confirm that percutaneous access is safe, and its use should be encouraged when any contraindication on his employment does not exist.


KEY WORDS: Aortic aneurysm, abdominal; Complications; Femoral artery; Ankle-Brachial Index

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