Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair
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Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair. / Eilenberg, Wolf; Kölbel, Tilo; Rohlffs, Fiona; Oderich, Gustavo; Eleshra, Ahmed; Tsilimparis, Nikolaos; Debus, Sebastian; Panuccio, Giuseppe.
In: J VASC SURG, Vol. 73, No. 5, 05.2021, p. 1498-1503.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair
AU - Eilenberg, Wolf
AU - Kölbel, Tilo
AU - Rohlffs, Fiona
AU - Oderich, Gustavo
AU - Eleshra, Ahmed
AU - Tsilimparis, Nikolaos
AU - Debus, Sebastian
AU - Panuccio, Giuseppe
N1 - Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - OBJECTIVE: We studied the outcomes of transfemoral access (TFA) vs upper extremity access (UEA) for branched endovascular aortic repair (BEVAR).METHODS: From January 2016 to October 2019, 152 consecutive patients underwent BEVAR under general anesthesia at a single institution. In 2018, an alternative approach to the antegrade branches using TFA compared with conventional UEA was introduced. The cohort was divided into TFA and UEA groups according to the access approach. The end points were technical success, adverse events (including perioperative stroke/transient ischemic attack), access complications, operation time, and radiation exposure.RESULTS: The TFA group included 60 patients (63% male; median age, 71 years; interquartile range [IQR], 65-76 years). The UEA group included 92 patients (67% male; median age, 73 years; IQR, 66-78 years). The number of target vessels (TVs) was similar in both groups (median, 4.0 TVs per procedure; range, 1-7 TVs for both). Technical success was greater in the TFA group (60 of 60 patients; 209 of 209 TVs) than in the UEA group (87 of 92 patients; 334 of 346 TVs; P < .01). The fluoroscopy time (median, 69 minutes; IQR, 48-87 minutes; vs 88 minutes; IQR, 65-104 minutes; P = .39) and contrast agent volume (median, 141 mL; IQR, 123-165 mL; vs median, 130 mL; IQR, 101-157 mL; P = .34) were similar in both groups. The radiation exposure (221 Gy × cm2; IQR, 138-406 Gy × cm2; vs median, 255 Gy × cm2; IQR, 148-425 Gy × cm2; P = .05) was lower and the operation time (median, 300 minutes; IQR, 240-356 minutes; vs median, 364 minutes; IQR, 290-475 minutes; P = .01) was shorter in the TFA group. Brachial access complications (0 of 60 vs 3 of 92 patients) and perioperative strokes/transient ischemic attacks (0 of 60 vs 8 of 92 patients) only occurred in the UEA group (P = .018).CONCLUSIONS: The use of TFA to catheterize antegrade branches was associated with a lower rate of complications in the present study and has become our preferred approach for BEVAR.
AB - OBJECTIVE: We studied the outcomes of transfemoral access (TFA) vs upper extremity access (UEA) for branched endovascular aortic repair (BEVAR).METHODS: From January 2016 to October 2019, 152 consecutive patients underwent BEVAR under general anesthesia at a single institution. In 2018, an alternative approach to the antegrade branches using TFA compared with conventional UEA was introduced. The cohort was divided into TFA and UEA groups according to the access approach. The end points were technical success, adverse events (including perioperative stroke/transient ischemic attack), access complications, operation time, and radiation exposure.RESULTS: The TFA group included 60 patients (63% male; median age, 71 years; interquartile range [IQR], 65-76 years). The UEA group included 92 patients (67% male; median age, 73 years; IQR, 66-78 years). The number of target vessels (TVs) was similar in both groups (median, 4.0 TVs per procedure; range, 1-7 TVs for both). Technical success was greater in the TFA group (60 of 60 patients; 209 of 209 TVs) than in the UEA group (87 of 92 patients; 334 of 346 TVs; P < .01). The fluoroscopy time (median, 69 minutes; IQR, 48-87 minutes; vs 88 minutes; IQR, 65-104 minutes; P = .39) and contrast agent volume (median, 141 mL; IQR, 123-165 mL; vs median, 130 mL; IQR, 101-157 mL; P = .34) were similar in both groups. The radiation exposure (221 Gy × cm2; IQR, 138-406 Gy × cm2; vs median, 255 Gy × cm2; IQR, 148-425 Gy × cm2; P = .05) was lower and the operation time (median, 300 minutes; IQR, 240-356 minutes; vs median, 364 minutes; IQR, 290-475 minutes; P = .01) was shorter in the TFA group. Brachial access complications (0 of 60 vs 3 of 92 patients) and perioperative strokes/transient ischemic attacks (0 of 60 vs 8 of 92 patients) only occurred in the UEA group (P = .018).CONCLUSIONS: The use of TFA to catheterize antegrade branches was associated with a lower rate of complications in the present study and has become our preferred approach for BEVAR.
KW - Aged
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Brachial Artery/diagnostic imaging
KW - Catheterization, Peripheral/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Femoral Artery/diagnostic imaging
KW - Humans
KW - Male
KW - Postoperative Complications/etiology
KW - Punctures
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Upper Extremity/blood supply
U2 - 10.1016/j.jvs.2020.11.020
DO - 10.1016/j.jvs.2020.11.020
M3 - SCORING: Journal article
C2 - 33248122
VL - 73
SP - 1498
EP - 1503
JO - J VASC SURG
JF - J VASC SURG
SN - 0741-5214
IS - 5
ER -
