Obesity not a contraindication for percutaneous TEVAR


A review of the safety of percutaneous thoracic endovascular aneurysm repair (TEVAR) was presented to delegates at the Vascular Annual Meeting (30 May–1 June 2013, San Francisco, USA). It was said in the presentation that there were currently limited data regarding the preclose technique, but that obesity does not seem to be a contraindication.

Jason Zakko, a medical student in the Department of Surgery, University of Florida, Gainesville, USA, told delegates that all data from 2005 to 2011 of patients undergoing percutaneous TEVAR with the preclose technique were reviewed. The patients in the percutaneous TEVAR cohort were stratified by body mass index.

Of 536 TEVAR procedures, 359 were percutaneous interventions. The percutaneous TEVAR patient group, according to Zakko, had a mean age of 62.9±15.7 years and a mean body mass index of 27.5±5.4. The mean number of Perclose deployments was 2.1±0.4.

The preclose success rate, defined as ability to achieve haemostasis and maintain limb perfusion without the need for surgical vessel repair, was 92.6% (non-obese 92.2%; obese 93.8%; p=0.57). Two obese patients and one non-obese patient required additional operations.

Univariate analysis revealed, according to Zakko, that higher age, increased sheath size, large aortic stent diameter, the use of two or more Perclose devices, the need for iliac stents and higher femoral artery calcium score were indicators of an increased risk of failure, but not obesity.

Zakko concluded: “Obesity does not appear to be a contraindication for the preclose technique”. He also recommended that, for patients that may require adjunctive stenting or who have smaller access vessel diameters with a greater degree of calcification, this particular technique should be used selectively.