Percutaneous access for Evar: Case–control study

Objective

Comparative and descriptive analysis of the outcomes of percutaneous access for EVAR (pEVAR) compared to the control group submitted to surgical femoral access (cEVAR).

Methods

Retrospective case–control analysis between January 2013 and January 2015 of the outcomes of pEVAR (group 1) compared to a control group of cEVAR (group 2) taking into account the demographic data and the primary endpoints: Access complication and surgical time; and secondary endpoints: type of anaesthesia, length of hospital stay and hematic loss. The statistical analysis was performed with the SPSS 23.0 programme using the X2 test for categorical variables and t test for continuous variables.

Results

A total of 6 pEVAR cases were performed in the selected period. A random selection of 20 cEVAR control cases was obtained. The mean age was 75 years, 85% were male. There were no significant differences in comorbidities between the two groups; the most frequent were arterial hypertension, dyslipidaemia, COPD/CID and CRD. There were no differences in major access complications (haemorrhage, lymphatic drainage, pain and oedema), however more frequently in cEVAR, with a significant rate of minor complications such as bruising in pEVAR (3.5% vs. 11.5%, p = 0.008). The surgical time was not significantly higher in cEVAR (p = 0.21), but the median is greater than in pEVAR with equally high in-group variance (cEVAR vs. pEVAR: 169 vs. 209 min; ANOVA: p < 0.05). Analysing secondary endpoints, the most widely used anaesthesia was the epidural (p = 0.03), hospital stay was higher in cEVAR (6.15 vs. 3.17; p = 0.022), a fact not observed in hematic loss (p = 0.17) despite the trend towards greater loss in cEVAR (group 1 and 2: 1.4 vs. 2.8 mg/dl).

Conclusion

Percutaneous access for EVAR demonstrates equal efficacy and safety compared to surgical femoral access, with shorter surgical time and hospitalization and less hematic loss without increasing local complications.