Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts Leonardo R. de Souza, MD, Gustavo S. Oderich,

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Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts Leonardo R. de Souza, MD, Gustavo S. Oderich, MD, Peter V. Banga, MD, Janet M. Hofer, RN, Jean R. Wigham, RN, Stephen Cha, MS, Peter Gloviczki, MD Journal of Vascular Surgery Volume 62, Issue 6, Pages 1442-1449.e3 (December 2015) DOI: 10.1016/j.jvs.2015.07.072 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig Kaplan-Meier analysis shows freedom from access-related complications. The dashed line indicates the 95% confidence interval (CI). Journal of Vascular Surgery 2015 62, 1442-1449.e3DOI: (10.1016/j.jvs.2015.07.072) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 1 (online only) The ultrasound guidance secures a puncture proximal to the femoral bifurcation and in the anterior wall of the artery. Whether to perform the puncture using a (A) transverse or a (B) longitudinal view is the surgeon's preference. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Journal of Vascular Surgery 2015 62, 1442-1449.e3DOI: (10.1016/j.jvs.2015.07.072) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 2 (online only) Preoperative imaging evaluation and adequate patient selection are necessary to obtain satisfactory results. A and B, Areas with severe and circumferential calcification are avoided and may be a contraindication to the total percutaneous procedure. C, A high femoral artery bifurcation requires additional care to avoid distal punctures. Journal of Vascular Surgery 2015 62, 1442-1449.e3DOI: (10.1016/j.jvs.2015.07.072) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 3 (online only) A, A small oblique incision is made. B, The subcutaneous tissue is dilated circumferentially to facilitate placement of the percutaneous vascular closure devices (PVCDs) and to avoid the inclusion of subcutaneous tissue in the suture. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Journal of Vascular Surgery 2015 62, 1442-1449.e3DOI: (10.1016/j.jvs.2015.07.072) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 4 (online only) A, It is important that both of the devices be introduced at the 12:00 o'clock position and at a ∼45° angle from the skin. B, After confirmation that the device is inside the vessel, the first one should be rotated to the 10:30 o'clock position before the following steps for its complete delivery. C, The second device is introduced in the same fashion as the first one but is rotated to the 1:30 o'clock position. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Journal of Vascular Surgery 2015 62, 1442-1449.e3DOI: (10.1016/j.jvs.2015.07.072) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 5 (online only) A, Obtaining adequate sealing of the large-sheath device arterial puncture is expected when two devices are used; however, a series of mechanisms may act to promote the failure of the technique. Inadequate sealing may result from (B) partial or (C) total inclusion of the inguinal ligament in the suture. D, As it occurs in the open technique, anterior plaques may prevent the effective suture of the puncture. E and F, Similar to the inguinal ligament, the dermis and the subcutaneous tissue may be included in the suture. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Journal of Vascular Surgery 2015 62, 1442-1449.e3DOI: (10.1016/j.jvs.2015.07.072) Copyright © 2015 Society for Vascular Surgery Terms and Conditions