Abstract: Objective To evaluate the long-term outcome of the femoral artery following total percutaneous endovascular aortic
repair (EVAR) with preclose technique using a vascular closure device (VCD). Methods From July, 2009 to July, 2012, total
percutaneous EVAR was performed in 113 patients (106 males, 7 females; mean age 59.4±13.5 years) with pre-close technique,
including 60 with Stanford type B aortic dissection, 3 with thoracic aortic aneurysm, and 48 with infra-renal abdominal aortic
aneurysm, and 2 with thoracic and abdominal aortic aneurysms. The Technical success and complication rates were evaluated,
and the outcomes of the femoral artery were followed up with computed tomography or color Doppler ultrasound. Results
The overall technical success rate was 97.6% (161/165) with conversion to open surgery in 4 cases. The size of the sheaths used
were 24Fr (n=37), 22Fr (n=29), 20Fr (n=24), 18Fr (n=25), 16Fr (n=12) and 14 Fr (n=38), and 347 VCDs were used for hemostasis of
165 femoral sites; 147 femoral sites were closed using 2 VCDs. Four access-related adverse events, including femoral
arterial-venous fistula, acute femoral thrombosis, bleeding, and lower extremity ischemia, occurred in 4 (2.4%) of the 165 cases.
In cases using ≤18Fr sheaths, the success rate of closure using 2 VCDs was 98.7%, as compared to 81.1% in cases using larger (≥
20Fr) sheaths (P=0.0003). The success rate of the 82 anterior sites was lower than that of the 82 posterior sites (82.9% vs 95.2%,
P=0.013). No lower extremity ischemia was observed, nor was femoral artery stenosis detected during the follow-up for 26±9
months (12-50 months) in these cases. Conclusion Total percutaneous EVAR with preclose technique using VCD provides a
safe and effective alternative to open femoral surgery. The sheath size can be a predictor of percutaneous access failure to
require conversion to open femoral surgery or using more than 2 devices for suture. Total percutaneous endovascular aortic
repair using VCD with preclose technique is safe and effective, which can be adopted as an alternative technique of surgically
femoral arterial cut-down operation when the surgeon reduce the learning curve.