Safety of Percutaneous TEVAR in Obese Patients

There are limited data describing the “Preclose” technique in TEVAR (P-TEVAR), particularly in obese patients (BMI ≥ 30kg/m2), in whom this technique is thought to be contraindicated. We describe our experience with P-TEVAR and compare outcomes in obese and nonobese patients. All patients undergoing TEVAR at a single institution from '05-11 were reviewed; patients undergoing P-TEVAR were identified and stratified by BMI. Technical success was defined as the ability to achieve hemostasis and maintain limb perfusion without the need for surgical repair of the vessel. Of 536 TEVARs, 359 (67%) P-TEVAR procedures were completed. For the entire P-TEVAR cohort, mean age ± SD was 62.9 ± 15.7 yrs with BMI of 27.5 ± 5.4. Mean sheath diameter, largest TEVAR stent diameter, and number of Perclose deployments were 22.4 ± 2.5F, 34.6 ± 7.8 mm and 2.1 ± 0.4, respectively. Mean access vessel inner diameter was 8.0 ± 2.0 mm with average depth of 35.6 ± 17.5 mm. Adjunctive iliac stents were used in 9.4% (n = 34). Overall “Preclose” success rate was 92.6%:92.2% for nonobese patients and 93.8% for obese patients (P = .57). 3 patients required subsequent operations for access complications: two obese patients (2%) and one nonobese patient (0.3%). By univariate analysis, higher age, increased sheath size, larger aortic stent diameter, use of more than 2 Perclose devices, need for iliac stents, and higher femoral artery calcium score were associated with failure. Independent predictors of failure were adjunctive iliac stent (OR, 8.9; 95% CI, 2.9-27.4; P = .003), >2 Perclose devices (OR, 6.7; 95% CI, 2.2-20.2; P = .001), and decreased access vessel diameter (OR, 1.5; 95% CI, 1.1-2; P = .008). Percutaneous endovascular repair of thoracic aortic pathology is safe. Obesity does not appear to be a contraindication for the “Preclose” technique. Patients predicted to need adjunctive stenting or possessing smaller access vessel diameters with greater degree of calcification are at highest risk of failure and selective use of this technique is recommended.