Ankle-Brachial Index evaluation in totally percutaneous approach vs. femoral artery cutdown for endovascular aortic repair of abdominal aortic aneurysms

BACKGROUND: Endovascular abdominal aortic aneurysm repair (EVAR) should be considered as the preferred treatment modality for infrarenal abdominal aortic aneurysm for patients with suitable anatomy and reasonable life expectancy. Surgical cut-down of both femoral arteries during EVARprocedure is associated with an increased risk of local complications. Therefore, nowadays most EVARprocedures are performed with a totally percutaneous approach. METHODS: Based on the evaluation of the Ankle Brachial Index (ABI) variation, the purpose of this study was to evaluate possible hemodynamic alterations on arterial perfusion of the lower limbs in two different types of access for EVARprocedures: totally percutaneous (p-EVAR) and EVARwith surgical access (s-EVAR). RESULTS: Our study considered 38 patients (36 men, mean age of 70.6±8.3 years) subjected to EVARprocedure between January 1, 2019 and December 31, 2020. The variation in pre- and postoperative ABI values (Δ ABI) and procedure-related complications rate were considered as primary outcomes. The p-EVARgroup consisted of 27 patients (92.6% males, mean age of 72.3±8.6) while the s-EVARgroup was composed by 11 patients (100% males, mean age of 69±8.1). The follow-up period was ranged from a minimum of 6 to a maximum of 12.3 months. In particular, the pre- and postoperative Δ ABI and the procedure-related complications rate, both considered as primary outcomes, did not show any significant difference between two groups, and in both groups, the technical success rate was 100%. CONCLUSIONS: Pre- and postoperative Δ ABI and the procedure-related complications rate, did not show any significant difference between two groups. We can confirm that percutaneous access is safe, and its use should be encouraged when any contraindication on his employment does not exist.