Percutaneous access for endovascular aortic aneurysm repair: A systematic review and meta-analysis

Vascular. 2016 Dec;24(6):638-648. doi: 10.1177/1708538116639201. Epub 2016 Mar 21.


Purpose: Our objective was to undertake a comprehensive review of the literature and conduct an analysis of the outcomes of percutaneous endovascular aneurysm repair.

Methods: MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry;; and ISRCTN Register, and bibliographic reference lists were searched to identify all studies providing comparative outcomes of the percutaneous technique for endovascular aneurysm repair. Success rate and access-related complications were defined as the primary outcome parameters. Combined overall effect sizes were calculated using fixed effect or random effects models. We conducted a network meta-analysis of different techniques for femoral access applying multivariate meta-analysis assuming consistency.

Findings: Three randomised controlled trials and 18 observational studies were identified. Percutaneous access was associated with a lower frequency of groin infection (p < 0.0001) and lymphocele (p = 0.007), and a shorter procedure time (p < 0.0001) and hospital length of stay (p = 0.03) compared with open surgical access. Moreover, percutaneous endovascular aneurysm repair did not increase the risk of haematoma, pseudoaneurysm, and arterial thrombosis or dissection.

Conclusion: Percutaneous access demonstrates advantages over conventional surgical exposure for endovascular aneurysm repair, as indicated by access-related complications and hospital length of stay. Further research is required to define its impact on resource utilization, cost-effectiveness and quality of life.

Keywords: Aortic aneurysm; EVAR; endovascular aneurysm repair; femoral cutdown; percutaneous access.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm / diagnostic imaging
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / methods*
  • Blood Vessel Prosthesis Implantation / mortality
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / methods*
  • Catheterization, Peripheral / mortality
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / methods*
  • Endovascular Procedures / mortality
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Punctures
  • Risk Factors
  • Time Factors
  • Treatment Outcome