Die Fasziennaht zum Verschluss von perkutanen Gefäßzugängen nach endovaskulären Aorteneingriffen

Endovascular repair of aortic lesions requires large bore femoral access (up to 26 F) for transfemoral stent graft delivery. Surgical cut down of the common femoral artery is still the most frequently used technique for groin management in EVAR and TEVAR procedures even though it prolongs operating time, increases tissue trauma and is associated with a variety of potential complications.It has been shown that a total percutaneous access using closure devices can reduce operating time, tissue trauma and as a result the time to ambulation. An alternative technique to simplify groin management in endovascular procedures has been described in 1997 to avoid surgical cut down and the use of expensive closure devices. This technique is today known as the fascia suturing technique. After the percutaneous procedure is completed a small oblique incision is made in the groin fold on either side of the puncture site exposing the cribriform fascia and a deep paravascular suture of the fascia is performed followed by a self-closing knot to cover the common femoral artery access. The published literature is summarized and our clinical experiences with the fascia suturing closure technique, which has been exclusively used for closure of all large (16-26 F) femoral access sites in a total of 110 groins over an 11-month period, are presented.