***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Percutaneous access during endovascular aneurysm repair has been difficult owing to the large size of the delivery catheters . This study reports a single-center experience of totally percutaneous access during endovascular abdominal and thoracic aortic repairs using the Preclose Proglide device ( Abbott Vascular , Redwood City , Calif ) . METHODS Between December 2004 and August 2006 , 262 endovascular aortic aneurysm repairs were performed .  Percutaneous access was used for the introduction of 12F to 24F sheaths ( 4.4-mm to 8.6-mm outer diameter ) . The technique involved deployment of two Proglide devices before insertion of the sheath ( " Preclose " technique ) with the sutures left extracorporeally for closure after conclusion of the procedure . A prospect ively maintained endovascular data base and medical records were retrospectively review ed . Rates of technical success , failure modes , and the overall duration of the endovascular repair compared with a similar cohort using open femoral exposures were examined . RESULTS A total of 559 Proglide devices were used to close 279 femoral arteries , and 175 ( 63 % ) required the insertion of 18F to 24F sheaths . There were 16 failures , mainly due to obesity , device malfunction , severe calcific disease , and faulty arterial punctures , for a technical success rate of 94.3 % . The success rates for 12F to 16F size sheaths were significantly higher than for the larger 18F to 24F sheaths ( 99.0 % vs 91.4 % , P<.01 ) . For both endovascular abdominal ( EVAR ) and thoracic ( TEVAR ) aortic repairs , the Preclose technique result ed in shorter overall procedure times compared with a similar cohort in which open femoral exposures were used ( EVAR , 115 vs 128 min , P<.001 ; TEVAR , 80 vs 112 , P=.019 ) . Despite this reduction of procedure time , the savings on the cost of operating room time was negated by the cost of the Proglide devices ( $ 295 per device ) . CONCLUSIONS Percutaneous access for endovascular aortic repair is safe and feasible using the Proglide device . Although the success rates are higher for smaller size sheaths , successful closures may be obtained for up to 24F sheaths . Percutaneous access may result in shorter overall procedure times and potentially lower operating room costs , but this appears to be offset by the cost of the closure devices OBJECTIVE The first multicenter r and omized controlled trial was design ed and conducted to assess the safety and effectiveness of  totally percutaneous endovascular aortic aneurysm repair ( PEVAR )  with use of a 21F endovascular stent graft system and either an 8 F or 10 F suture-mediated closure system ( the PEVAR trial , NCT01070069 ) . A noninferiority trial design was chosen to compare percutaneous access with st and ard open femoral exposure . METHODS Between 2010 and 2012 , 20 U.S. institutions participated in a prospect i ve , Food and Drug Administration-approved r and omized trial to evaluate percutaneous femoral artery access and closure by a " preclose " technique in conjunction with endovascular abdominal aortic aneurysm repair . A total of 151 patients were allocated by a 2:1 design to percutaneous access/closure ( n = 101 ) or open femoral exposure ( n = 50 [ FE ] ) . PEVAR procedures were performed with either the 8 F Perclose ProGlide ( n = 50 [ PG ] ) or the 10 F Prostar XL ( n = 51 [ PS ] ) closure devices . All endovascular abdominal aortic aneurysm repair procedures were performed with the Endologix 21 F profile ( outer diameter ) sheath-based system . Patients were screened by computed tomography with three-dimensional reconstruction and independent physician review for anatomic suitability and adequate femoral artery anatomy for percutaneous access . The primary trial end point ( treatment success ) was defined as procedural technical success and absence of major adverse events and vascular complications at 30 days . An independent access closure sub study evaluated major access-related complications . Clinical utility and procedural outcomes , ankle-brachial index , blood laboratory analyses , and quality of life were also evaluated with continuing follow-up to 6 months . RESULTS Baseline characteristics were similar among groups . Procedural technical success was 94 % ( PG ) , 88 % ( PS ) , and 98 % ( FE ) . One-month primary treatment success was 88 % ( PG ) , 78 % ( PS ) , and 78 % ( FE ) , demonstrating noninferiority vs FE for PG ( P = .004 ) but not for PS ( P = .102 ) . Failure rates in the access closure sub study analyses demonstrated noninferiority of PG ( 6 % ; P = .005 ) , but not of PS ( 12 % ; P = .100 ) , vs FE ( 10 % ) . Compared with FE , PG and PS yielded significantly shorter times to hemostasis and procedure completion and favorable trends in blood loss , groin pain , and overall quality of life . Initial noninferiority test results persist to 6 months , and no aneurysm rupture , conversion to open repair , device migration , or stent graft occlusion occurred . CONCLUSIONS Among trained operators , PEVAR with an adjunctive preclose technique using the ProGlide closure device is safe and effective , with minimal access-related complications , and it is noninferior to st and ard open femoral exposure . Training , experience , and careful application of the preclose technique are of paramount importance in ensuring successful , sustainable outcomes BACKGROUND Although endovascular aneurysm repair ( EVAR ) has a lower 30-day operative mortality than open repair , the long-term results of EVAR are uncertain . We instigated EVAR trial 1 to compare these two treatments in terms of mortality , durability , health-related quality of life ( HRQL ) , and costs for patients with large abdominal aortic aneurysm ( AAA ) . METHODS We did a r and omised controlled trial of 1082 patients aged 60 years or older who had aneurysms of at least 5.5 cm in diameter and who had been referred to one of 34 hospitals proficient in the EVAR technique .  We assigned patients who were anatomically suitable for EVAR and fit for an open repair to EVAR ( n=543 ) or open repair ( n=539 ) . Our primary endpoint was all-cause mortality , with secondary endpoints of aneurysm related mortality , HRQL , postoperative complications , and hospital costs . Analyses were by intention to treat . FINDINGS 94 % ( 1017 of 1082 ) of patients complied with their allocated treatment and 209 died by the end of follow-up on Dec 31 , 2004 ( 53 of aneurysm-related causes ) . 4 years after r and omisation , all-cause mortality was similar in the two groups ( about 28 % ; hazard ratio 0.90 , 95 % CI 0.69 - 1.18 , p=0.46 ) , although there was a persistent reduction in aneurysm-related deaths in the EVAR group ( 4%vs 7 % ; 0.55 , 0.31 - 0.96 , p=0.04 ) . The proportion of patients with postoperative complications within 4 years of r and omisation was 41 % in the EVAR group and 9 % in the open repair group ( 4.9 , 3.5 - 6.8 , p<0.0001 ) . After 12 months there was negligible difference in HRQL between the two groups . The mean hospital costs per patient up to 4 years were UK pound sterling 13,257 for the EVAR group versus pound sterling 9946 for the open repair group ( mean difference pound sterling 3311 , SE 690 ) . INTERPRETATION Compared with open repair , EVAR offers no advantage with respect to all-cause mortality and HRQL , is more expensive , and leads to a greater number of complications and re interventions . However , it does result in a 3 % better aneurysm-related survival . The continuing need for interventions m and ates ongoing surveillance and longer follow-up of EVAR for detailed cost-effectiveness assessment PURPOSE To evaluate safety and cost benefits of the percutaneous technique for treatment of aortic aneurysm , a prospect i ve r and omized study was performed that compared the endovascular suture technique with conventional cutdown access and repair . MATERIAL S AND METHODS From January 2002 through July 2002 , 30 endografts , including 14 Talent stent-grafts ( Medtronic , Sunrise , Fla ) and 16 Zenith endografts ( Cook , Bloomington , Ind ) were implanted in 30 patients for endovascular aneurysm treatment . The patients were r and omized to either  percutaneous technique ( group A ) or conventional cutdown ( group B ) . Fifty-five femoral arteries were cannulated with large-bore ( 14F-25F ) introducers and were included in the study . Safety and efficiency of both techniques were assessed by recording the complication rates , operation time , discharge , and time to ambulation . Comparison of selected estimated costs included both variable and fixed costs for femoral access and expenses for treatment of complications . RESULTS No operative deaths occurred . The complication rates were similar and included 1 arterial thrombosis in each group , 3 lymphoceles in group B , and 1 conversion to cutdown because of bleeding in group A. Mean surgery time ( 86.7 + /- 27 minutes vs 107.8 + /- 38.5 minutes ; P < .05 ) and time to ambulation ( 20.1 + /- 4.3 hours vs 33.1 + /- 18.4 hours ; P < .001 ) were significantly shorter in the group treated percutaneously . Because of the cost of the closure device , total cost of the percutaneous technique averaged 99.2 euro ; more than cutdown . CONCLUSIONS The percutaneous technique decreases the invasiveness of endovascular therapy of aortic aneurysm and reduces operative time and time to ambulation . Complications were roughly equivalent in severity . The additional cost for the device appears to justify its use for this form of aneurysm treatment PURPOSE This study was design ed to describe and evaluate our preliminary results with a percutaneous arterial closure device as compared to those obtained with conventional femoral surgical cut down during endovascular repair of abdominal aortic aneurysms ( AAA ) . MATERIAL AND METHODS Between January 2004 and December 2006 , 40 of 86 AAA patients selected for endovascular repair met the criteria for inclusion in this study . Nineteen of these patients ( Group A ) received a bifurcated endograft placed by direct puncture of the femoral arteries ( 38 femoral triangles ) with closure by a Prostar((R ) ) percutaneous arterial closure device ( Abbott ) . The other 21 patients ( control group B ) were managed with a bifurcated endograft placed by conventional open surgery ( 42 femoral triangles ) . Data concerning all 40 patients were collected prospect ively and analyzed . RESULTS The technical success rate was 92 % ( group A ) vs 90 % ( group B ) , P=0.79 . The incidence of perioperative complications was 16 % ( 3/19 ) in group A and 14 % ( 3/21 ) in group B ( P=0.89 ) . The mean hospital stay was 5.8 days in group A and 7.8 days in group B ( P=0.05 ) . The difference in the length of hospitalisation was associated with reduced cost for the percutaneous group ( 5579.60 euros vs. 7503.60 euros ; P=0.04 ) , that counterbalanced the cost induced by the Prostar XL((R ) ) suture mediated device . Mean follow-up in both groups was 12 months . The overall incidence of locoregional complications after one year of follow-up was 11 % ( 2/19 ) in group A and 19 % ( 4/21 ) in group B ( P=0.45 ) . CONCLUSION This study confirms the feasibility and safety of total percutaneous endovascular AAA repair . Our preliminary results suggest that the costs paid by healthcare providers for endovascular AAA repair might not be increased with the selective use of percutaneous closure devices Endovascular exclusion of abdominal aortic aneurysms ( AAAs ) was developed in an effort to treat patients who were at high risk for complications following st and ard surgical repair .  Stent grafts used for endovascular repair of AAAs require the use of large‐bore sheaths and surgical exposure of the common femoral arteries ( CFAs ) . To decrease the invasiveness of AAA repair , we attempted to perform the procedure percutaneously utilizing the Prostar XL Percutaneous Vascular Surgery Device and the preclose technique . Thirty patients underwent an attempted percutaneous AAA repair . These patients were followed prospect ively to assess the success of the procedure . Twenty‐eight patients ( 93 % ) had successful percutaneous repair of both CFA access sites . One patient had inadequate hemostasis of the 22 Fr CFA entry site and one patient had inadequate hemostasis of the 16 Fr CFA entry site . Both of these CFA sites underwent open 
    Output:
    
Conclusion : PEVAR had a similar technical success rate , shorter procedure time , and lower complication rate compared with OFA .
Thus , percutaneous access appears to be the preferential approach for EVAR .