Totally percutaneous aneurysm repair was originally described by Haas, Krajcer and Diethrich in 1999. The procedure involves placement of arterial sutures prior to performance of standard endovascular aneurysm repair (EVAR) with large bore arterial sheaths. This is made possible with a suture-mediated arterial closure device (Prostar® XL 10Fr) manufactured by Abbott Vascular (Perclose: Menlo Park, CA) and has been dubbed the "Pre-close" technique.

Our institutional data suggests that certain patients are at high risk for conversion and/or complication with totally percutaneous aneurysm repair. Namely, morbidly obese patients (Body Mass Index > 35 kg/m²), and those with circumferential arterial calcification of the common femoral arteries are at higher risk for conversion to open femoral arterial repair.

The procedure depicted in this movie involves repair of a 5.6cm infra-renal abdominal aortic aneurysm on a 69 year old Caucasian male with a history of hypertension.

Totally percutaneous aneurysm repair utilizing the "Pre-close" technique is a safe and effective means of treating patients presenting for EVAR. This technique avoids the use of standard femoral arterial exposure and potentially limits associated morbidity. This procedure should only be performed by experienced operators on carefully selected patients. A capability for expeditious open femoral arterial repair is mandatory when using this approach.