Incidence and prognostic factors related to major adverse cerebrovascular events in patients with complex aortic diseases treated by the chimney technique

Bosiers, Michel; Tran, Kenneth; Lee, Jason T.; Donas, Konstantinos P.; Veith, Frank J.; Torsello, Giovanni; Pecoraro, Felice; Stavroulakis, Konstantinos; Dalman, Ronald L.; Lachat, Mario; Bisdas, Theodosios; Seifert, Sven; Esche, Mirko; Gasparini, Daniele; Frigatti, Paolo; Adovasio, R; Mucelli, Fabio Pozzi; Damrauer, Scott M.; Woo, Edward Y.; Beck, Adam W.; Scali, Salvatore T.; Minion, David J.; Salenius, Juha; Suominen, Velipekka; Mangialardi, Nicola; Ronchey, Silvia; Fazzini, Stefano; Mestres, Gaspar; Riambau, Vincent; Mosquera, Nilo J.

doi:10.1016/j.jvs.2017.08.079

Cited by 26 publications

(24 citation statements)

References 31 publications

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“…One study presented neither age and gender nor prevalence of hypertension (Table 1) [22]. Four studies did report on the number of patients on preprocedural thrombocyte aggregation inhibition, ranging from 66 to 100% [10,12,20,27]. Aneurysm extent included 262 thoracoabdominal aortic aneurysms [10,11,21,[27][28][29] and 867 complex (from juxtarenal to paravisceral) abdominal aortic aneurysms [10-12, 16, 18-20, 23-25, 27, 28].…”

Section: Patient Demographics and Study Characteristicsmentioning

confidence: 99%

“…The mean diameter was reported by seven studies and ranged from 50 mm to 74 mm, and the overall mean diameter was 64 mm [11,18,19,[23][24][25]. Forty-five patients were treated in an acute setting (Table 1) [10,12]. All studies were hospitalbased and embraced vascular surgery patients.…”

Section: Patient Demographics and Study Characteristicsmentioning

confidence: 99%

“…All studies stated which aortic intervention was performed. In total, 583 chimney EVAR [12,16,19,20,24,25], 28 chimney endovascular aneurysm sealing (EVAS) [23], 210 fenestrated EVAR [18,20,22,27,28], 249 fenestrated/ branched EVAR [11,29] and 206 branched EVAR [10,21,26] were performed. The mean procedure time was reported by ten studies and ranged from 105 to 600 min.…”

Section: Procedural Detailsmentioning

confidence: 99%

“…Four studies did not report how many aortic side branches were treated (Table 1) [10,12,25]. [11,12,16,[18][19][20][21][22][23][24][25][26][27][28][29], right (n = 148) [10-12, 18, 22] or bilateral (n = 100) [12,19,20,24] upper extremity access for the treatment of aortic aneurysms. One article had a discrepancy between the total number of patients and the size of each group, mentioning 425 treated patients but 434 used access strategies [12].…”

Section: Procedural Detailsmentioning

confidence: 99%

“…There are different hypotheses for the cause of the increased incidence, such as arch manipulation, causing disruption of vulnerable plugs passing to the cerebral arteries, or the reduced flow in and distal to the brachiocephalic trunk due to temporary occlusion by the inserted sheath [9,10]. Several authors make different and contradictory statements about the influence of the choice of upper extremity access site on the cerebrovascular event risk, in particular whether right upper extremity access increases the risk [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions: A Systematic Review and Meta-Analysis

Meertens

Lemmens

Oderich

et al. 2019

Cardiovasc Intervent Radiol

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Purpose The purpose of this study was to review the risk of developing cerebrovascular complications from upper extremity access during endovascular treatment of complex aortic aneurysms. Methods A systematic review and meta-analysis were conducted according to the PRISMA guideline. An electronic search of the public domains Medline (PubMed), Embase (Ovid), Web of Science and Cochrane Library was performed to identify studies related to the treatment of aortic aneurysms involving upper extremity access. Metaanalysis was used to compare the rate of cerebrovascular event after left, right and bilateral upper extremity access. Results are presented as relative risk (RR) and 95% confidence intervals (CIs). Results Thirteen studies including 1276 patients with complex endovascular treatment of aortic aneurysms using upper extremity access were included in the systematic review. Left upper extremity access (UEA) was used in 1028 procedures, right access in 148 and bilateral access in 100 procedures. The rate of cerebrovascular complications for patients treated through left UEA was 1.7%, through right UEA 4% and through bilateral UEA 5%. In the metaanalysis, we included seven studies involving 645 patients treated with a left upper extremity access, 87 patients through a right and 100 patients through a bilateral upper extremity access. Patients, who underwent right-sided (RR 5.01, 95% CI 1.51-16.58, P = 0.008) or bilateral UEA (RR 4.57, 95% CI 1.23-17.04, P = 0.02), had a significantly increased risk of cerebrovascular events compared to those who had a left-sided approach. Conclusion Left upper extremity access is associated with a significantly lower rate of cerebrovascular complications as compared to right or bilateral upper extremity access.

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