Percutaneous Interventions in Aortic Disease

Percutaneous access techniques for diagnostic and therapeutic approaches to the coronary and aortic branch vessels have been the mainstay of cardiovascular interventions for several decades. The development of catheter-based technologies to treat traumatic and degenerative pathology of the thoracic and abdominal aorta initially required the use of direct femoral access via open incisions because of the size of the devices and their delivery sheaths. Although the endovascular repair of infrarenal aortic aneurysms (EVAR) ushered in an entirely new concept for managing aortic pathology, there was a concomitant development of a new series of complications associated with open vascular access. Of the devices approved by the US Food and Drug Administration, the profiles of the currently available components ranges from 9F to 25F inner diameter, which correlates to 11F to 27F outer diameter. In particular, delivery systems for thoracic endografts have 22F to 27F outer diameter and are traditionally placed via femoral artery cut-down or surgically created conduits. With the evolution of devices with smaller sheaths, the development of closure devices, and noninvasive imaging studies to assess the suitability of arteries for percutaneous access, there have been major changes in the approach and timing of aortic interventions.