To describe the downsizing post-closure technique for access hemostasis during emergency endovascular repair (EVAR) in ruptured abdominal aortic aneurysms (RAAA).

A cohort of eight patients underwent emergency EVAR through 16 femoral access sites for infrarenal RAAA. The downsizing post-closure technique, which involves a reduction in the size of the large-bore access by advancing a 10F sheath, was consistently applied. Technical success was defined as complete hemostasis without a bailout intervention. Primary outcome measure was the incidence of access-related complications. Secondary outcome measures included manual compression time, hemostasis time, hospital stay, additional use of Proglide, and the 30-day mortality rate.

The technique resulted in a 100% success rate (mean age: 69.5 ± 11.7 years; 75% males). The mean arterial sheath size was 18.1 ± 1.9F. The mean manual compression time was 3.6 ± 1.2 min, and the mean hemostasis time was 6.8 ± 1.4 min. No patients required additional use of Proglide, and no access-related complications were observed. The 30-day mortality rate was 12.5%.

The downsizing post-closure technique may offer an alternative for access hemostasis during emergency EVAR for RAAA. However, further evaluations through larger comparative studies are required.