Percutaneous access planning, techniques and considerations for endovascular aortic repair (EVAR)

Historically, repair of the aorta required open surgery accompanied by extended intensive care unit (ICU) admissions followed by multiple months before patients recovered to their initial baseline status. A large number of patients were not suitable candidates for open surgical repair of the aorta due to medical comorbidities and/or underlying frailty. With the introduction of the Seldinger technique, new frontiers of percutaneous endovascular repairs were unlocked. Initially, endovascular access for aortic repair was obtained with a surgical femoral cut-down with associated risks of femoral neuralgia, lymphoceles, hematoma and infection. With the advent of innovative percutaneous suture mediated vascular closure devices and lower profile endograft devices, entirely percutaneous endovascular access developed into a viable and arguably a preferable option for patients undergoing aortic repair (1)