Totally percutaneous abdominal and thoracic endovascular aneurysmal repair: 10-year experience of a tertiary cardiologic center

BACKGROUND: Endovascular repair of the abdominal (EVAR) and thoracic (TEVAR) aorta are major advance in the treatment of aortic aneurysms. Moreover, these procedures are now frequently handled directly by interventional cardiologists. While the experience in EVAR is well solid, for TEVAR limited evidence is available regarding the advantages of full endovascular versus over open surgical access in terms short-term complications.METHODS: In this cross-sectional study, we retrospectively assessed the short-term outcome and complications of full percutaneous EVAR and TEVAR among 210 patients referred to our center for aneurysm repair over the last decade. Of note, our center is lead only by Interventional Cardiologists with no vascular surgeons on-site.RESULTS: In EVAR group, we found a lower rate of access-site complication compared to TEVAR (4.0% vs. 9.6%) even if this difference did not reach the statistical significance (P=0.09). Moreover, we found no significantly difference in the rate of access complication related to common vascular closure devices between the two groups. Among short term complication, we found more frequently post-operative ischemic complication and anemia associated to TEVAR. At multivariate analysis diabetes was the main determinant for access complication risk. Interestingly, an increased EuroSCORE value in EVAR group was significantly associated to access complication, post-operative renal failure, anemia, stroke, ischemic complication and the presence on endoleak as complication.CONCLUSIONS: Totally percutaneous endovascular aneurysmal repair is feasible in the most cases, with a very low risk of access-related complication representing valuable therapeutic option for these patients, especially in centers with proven experience.