Seventeen studies (1,693 patients with 2,447 femoral access sites) were included in the review; one randomised controlled trial, eight prospective studies and eight retrospective studies. The Newcastle-Ottawa scores ranged from five points (one study) to the maximum nine points (two studies). Although one RCT was included in the review, only the treatment arm using percutaneous component was evaluated in the review.
In 10 out of 2,447 femoral access sites (4.1%), percutaneous endovascular aortic aneurysm repair was abandoned primarily due to access problems, and infections and stenosis each occurred in less than 1% of patients.
There was a significantly higher likelihood of a successful operation without conversion to femoral cutdown using sheaths smaller than 18F compared to the use of 20F or greater large-bore sheaths (OR 1.78, 95% CI 1.24 to 2.54). Meta-analyses of the prospective studies showed a marginally significant OR of 1.6 (95% CI 0.99 to 2.44) and the pooled OR of the retrospective studies was 2.24 (95% CI 1.25 to 4.02). A sensitivity analysis found that the benefits of using 18F or smaller sheaths were more pronounced when multiple rather than single suture-mediated vascular closure devices were used (OR 2.16, 95% CI 1.28 to 3.64).
There was no statistically significant heterogeneity observed across the studies for the results. There was no evidence of publication bias found using visual appraisal of the funnel plots or on the Begg and Egger tests.