Right brachial access is safe for branched endovascular aneurysm repair in complex aortic disease

Abstract

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.

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

“…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]. Two studies did not provide aneurysm classification [22,26].…”

“…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.…”

“…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.…”

“…In total, 2311 aortic side branches were included in the aneurysm repair. 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.…”

“…For example, complex EVAR interventions are known to increase peri-and post-interventional cerebrovascular event [cerebrovascular accident (CVA), transient ischemic attack (TIA)] risks compared to conventional EVARs [2,6]. 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].…”