Right brachial access is safe for branched endovascular aneurysm repair in complex aortic disease
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Right brachial access is safe for branched endovascular aneurysm repair in complex aortic disease. / Fiorucci, Beatrice; Kölbel, Tilo; Rohlffs, Fiona; Heidemann, Franziska; Debus, Sebastian Eike; Tsilimparis, Nikolaos.
In: J VASC SURG, Vol. 66, No. 2, 08.2017, p. 360-366.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Right brachial access is safe for branched endovascular aneurysm repair in complex aortic disease
AU - Fiorucci, Beatrice
AU - Kölbel, Tilo
AU - Rohlffs, Fiona
AU - Heidemann, Franziska
AU - Debus, Sebastian Eike
AU - Tsilimparis, Nikolaos
N1 - Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2017/8
Y1 - 2017/8
N2 - BACKGROUND: The risk of perioperative cerebrovascular events in endovascular repair of thoracic and thoracoabdominal aneurysms is reported from 2% to 15%. The unavoidable use of an upper extremity access during branched endovascular aneurysm repair (b-EVAR) may play a role in embolic brain injuries. For this reason, some advocate the use of a left-sided upper access to avoid crossing the origin of supra-aortic vessels. However, the assumption that right brachial access has a higher risk for stroke during b-EVAR has not been confirmed in the literature.METHODS: This study retrospectively analyzed all consecutive patients treated by b-EVAR with right brachial access at a single institution. A through-and-through right-brachiofemoral 0.014-inch wire was used to stabilize the sheath across the arch in all cases. End point of the study was the incidence of cerebrovascular events.RESULTS: We identified 61 patients (65.6% male) during a 4-year period. Mean age at the time of surgery was 70.4 years (range, 53-87 years). The most common indication for treatment was type II (32.8%), followed by type IV thoracoabdominal aortic aneurysms (23%). There were 20 urgent (32.8%) and 41 elective (67.2%) procedures. Two perioperative ischemic strokes occurred in the first postoperative day in two men (3.3%; 95% confidence interval, 0.397-11.84). No further ischemic strokes occurred perioperatively. There was no statistically significant association between the occurrence of postoperative stroke and any of the perioperative characteristics. No significant association was found between the duration of the procedure and the end point. In both patients with embolic events, the use of a left arm approach would not have been feasible due to coverage of the left subclavian artery ostium.CONCLUSIONS: The postoperative stroke rate in b-EVAR with the use of a right brachial access in our experience was in line with the literature for treatment of thoracic and thoracoabdominal aortic aneurysms. We conclude that the right brachial access with the use of a stabilizing through-and-through wire is a safe approach during b-EVAR.
AB - BACKGROUND: The risk of perioperative cerebrovascular events in endovascular repair of thoracic and thoracoabdominal aneurysms is reported from 2% to 15%. The unavoidable use of an upper extremity access during branched endovascular aneurysm repair (b-EVAR) may play a role in embolic brain injuries. For this reason, some advocate the use of a left-sided upper access to avoid crossing the origin of supra-aortic vessels. However, the assumption that right brachial access has a higher risk for stroke during b-EVAR has not been confirmed in the literature.METHODS: This study retrospectively analyzed all consecutive patients treated by b-EVAR with right brachial access at a single institution. A through-and-through right-brachiofemoral 0.014-inch wire was used to stabilize the sheath across the arch in all cases. End point of the study was the incidence of cerebrovascular events.RESULTS: We identified 61 patients (65.6% male) during a 4-year period. Mean age at the time of surgery was 70.4 years (range, 53-87 years). The most common indication for treatment was type II (32.8%), followed by type IV thoracoabdominal aortic aneurysms (23%). There were 20 urgent (32.8%) and 41 elective (67.2%) procedures. Two perioperative ischemic strokes occurred in the first postoperative day in two men (3.3%; 95% confidence interval, 0.397-11.84). No further ischemic strokes occurred perioperatively. There was no statistically significant association between the occurrence of postoperative stroke and any of the perioperative characteristics. No significant association was found between the duration of the procedure and the end point. In both patients with embolic events, the use of a left arm approach would not have been feasible due to coverage of the left subclavian artery ostium.CONCLUSIONS: The postoperative stroke rate in b-EVAR with the use of a right brachial access in our experience was in line with the literature for treatment of thoracic and thoracoabdominal aortic aneurysms. We conclude that the right brachial access with the use of a stabilizing through-and-through wire is a safe approach during b-EVAR.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Aneurysm, Abdominal/diagnostic imaging
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Aortography/methods
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Brachial Artery/diagnostic imaging
KW - Catheterization, Peripheral/adverse effects
KW - Computed Tomography Angiography
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Germany/epidemiology
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Prosthesis Design
KW - Punctures
KW - Retrospective Studies
KW - Risk Factors
KW - Stroke/epidemiology
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.jvs.2016.12.114
DO - 10.1016/j.jvs.2016.12.114
M3 - SCORING: Journal article
C2 - 28268106
VL - 66
SP - 360
EP - 366
JO - J VASC SURG
JF - J VASC SURG
SN - 0741-5214
IS - 2
ER -
