Carotid artery percutaneous access with vessel closure devices in endovascular aortic arch repairs

OBJECTIVE: To report the use of a percutaneous carotid access with vessel closure devices (VCDs) during complex endovascular aortic arch repair.

METHODS: Seven international high-volume centers conducted a retrospective review of all patients receiving percutaneous carotid access with VCD during endovascular aortic arch procedures to investigate its feasibility and safety. The primary end point was the closure success defined according to the modified Valve Academic Research Consortium-2 definition (no need for adjunctive surgical or endovascular procedures to obtain vessel closure and no hemorrhagic/stenotic complications).

RESULTS: A total of 46 patients (27 males [59%]; mean age, 74 years; range, 68-78 years) treated between January 2022 and September 2024 underwent endovascular arch procedures (eight urgent/emergent cases [19%]), all under general anesthesia and ultrasound guidance, using a micropuncture set in 32 cases (70%). The left common carotid artery was punctured in 41 cases (89%). The median introducer sheath inner diameter was 7F (range, 6F-8F). Only 1 VCD was used per access, with 19 cases (41%) using the preclose technique and 27 cases (59%) using the VCD after introduced sheath removal (all but one case treated with PerClose ProGlide [Abbott Vascular]). Closure success was achieved in 44 patients (96%): 1 patient required an intraoperative covered stent placement to cover the puncture site, and 1 patient required an open conversion 2 days after the procedure owing to a pseudoaneurysm diagnosed at the postoperative computed tomography scan. Four patients (9%) required prolonged manual compression after VCD tightening owing to oozing from the puncture site. The prolonged manual compression was correlated to the use of anticoagulants (40 vs 7%; P = .043). One case of a non-flow-limiting dissection was left untreated conservatively. Four patients (9%) suffered from postoperative stroke, two ischemic and two hemorrhagic, two on the same side of the carotid puncture and two on the contralateral side. No other complications were reported.

CONCLUSIONS: Percutaneous carotid access with a VCD appeared to be feasible and safe, with a high closure success rate. Further investigations are needed to compare open cutdown vs percutaneous access outcomes.