Estudo comparativo entre técnicas de acesso vascular para correção endovascular de aneurisma de aorta

Introduction: the global prevalence of abdominal aortic aneurysms was 0.92% in 2019, with regional variations related to risk factors and access to treatment. Endovascular repair has become the preferred approach due to its lower mortality rate than open surgery, with a significant increase in use between 2004 and 2015. Within this context, percutaneous endovascular repair has emerged as a minimally invasive alternative, associated with a reduction in complications and surgical time, although its effectiveness may be limited in cases of complex vascular anatomy. Percutaneous access to the femoral artery has been widely used, providing lower morbidity, emphasizing the importance of careful vascular planning. Objective: evaluating the experience of a vascular surgery service in using the percutaneous endovascular aneurysm repair technique and comparing the outcomes related to percutaneous access and conventional access by femoral dissection. Methods: this is an observational, descriptive, and retrospective study with a quantitative approach, conducted with 42 patients who consecutively underwent endovascular repair via percutaneous access or femoral dissection at a private tertiary hospital located in Santo André, São Paulo. Data was extracted from electronic medical records and organized into spreadsheets for analysis of clinical and epidemiological variables. Results: of the 67 patients initially assessed, 42 met the inclusion criteria, 71.43% were male and 28.57% female. Elective procedures accounted for 52.38% of cases, while 47.62% were emergency surgeries. The overall rate of local complications was 16.67%, and the perioperative mortality rate was 14.28%. There was a higher perioperative mortality rate in patients who underwent femoral dissection (20%) compared to puncture access (5.9%), although this was not statistically significant. The Perclose ProGlide device had a success rate of 98.48%. The most frequent pathology was abdominal aortic aneurysm (42.86%). Conclusion: the percutaneous approach had lower rates of local complications and perioperative mortality compared to femoral dissection, proving to be a safer and more effective alternative for the endovascular treatment of aortic pathologies. On the other hand, dissection, because it is a more invasive procedure, was associated with a higher incidence of local complications, reinforcing the preference for the percutaneous approach whenever technically feasible.