Tags

Type your tag names separated by a space and hit enter

A systematic review of outcomes of upper extremity access for fenestrated and branched endovascular aortic repair.

Abstract

OBJECTIVE

Upper extremity access (UEA) is an important component of complex fenestrated and branched endovascular aneurysm repair (F/BEVAR). Open and percutaneous UEA approaches have been reported during these procedures. The aim of this review was to assess the outcomes of UEA done to facilitate F/BEVAR.

METHODS

A systematic review of studies focusing on upper extremity arterial access during F/BEVAR was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Three databases including PubMed MEDLINE, Embase, and Cochrane Library were queried. Outcomes of interest included UEA-related and other unrelated early and late morbidity and mortality, such as arterial occlusion, neurologic deficit, bleeding complications, and stroke, in patients undergoing UEA during F/BEVAR.

RESULTS

Five full-text manuscripts and one abstract met criteria to be included, accounting for a total of 495 patients. The median age of patients who underwent UEA during F/BEVAR was 73.4 years. Predominantly male patients (371 [74.9%]) were treated. Indications for F/BEVAR were thoracoabdominal aortic aneurysms in 325 (65.6%), pararenal aneurysms in 96 (19.4%), juxtarenal aneurysms in 44 (8.9%), and suprarenal aortic aneurysms in 30 (6.1%). Axillary conduits were created in 29 (5.8%) patients. A total of 41 (8.2%) UEA-related complications were reported. Of those 41 complications, 17 (41.5%) were access bleeding, 10 (24.4%) were ischemic strokes, 7 (17.1%) were arterial occlusions, 4 (9.7%) were upper extremity neurologic deficits, 2 (4.9%) were arterial stenoses, and 1 (2.4%) was pseudoaneurysm. UEA-related complications were reported in 15 of 56 (26.8%) patients undergoing percutaneous UEA and 26 of 439 (5.9%) undergoing open UEA (P < .001).

CONCLUSIONS

The overall complication rate associated with UEA during F/BEVAR is low, with 2% stroke rate reported. The percutaneous approach showed a higher UEA-related complication rate compared with open UEA. More studies on percutaneous UEA and randomized studies comparing open vs percutaneous UEA during F/BEVAR are warranted to determine the safest and most efficient UEA approach strategy during complex aortic procedures.

Authors+Show Affiliations

Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany; Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz Medical Center, Aurora, Colo. Electronic address: rafael.malgor@ucdenver.edu.Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31740188

Citation

Malgor, Rafael D., et al. "A Systematic Review of Outcomes of Upper Extremity Access for Fenestrated and Branched Endovascular Aortic Repair." Journal of Vascular Surgery, 2019.
Malgor RD, Marques de Marino P, Verhoeven E, et al. A systematic review of outcomes of upper extremity access for fenestrated and branched endovascular aortic repair. J Vasc Surg. 2019.
Malgor, R. D., Marques de Marino, P., Verhoeven, E., & Katsargyris, A. (2019). A systematic review of outcomes of upper extremity access for fenestrated and branched endovascular aortic repair. Journal of Vascular Surgery, doi:10.1016/j.jvs.2019.09.028.
Malgor RD, et al. A Systematic Review of Outcomes of Upper Extremity Access for Fenestrated and Branched Endovascular Aortic Repair. J Vasc Surg. 2019 Nov 15; PubMed PMID: 31740188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review of outcomes of upper extremity access for fenestrated and branched endovascular aortic repair. AU - Malgor,Rafael D, AU - Marques de Marino,Pablo, AU - Verhoeven,Eric, AU - Katsargyris,Athanasios, Y1 - 2019/11/15/ PY - 2019/05/09/received PY - 2019/09/11/accepted PY - 2019/11/20/entrez PY - 2019/11/20/pubmed PY - 2019/11/20/medline KW - Axillary artery KW - Brachial artery KW - Branched KW - Endovascular aortic repair KW - Fenestrated KW - Percutaneous JF - Journal of vascular surgery JO - J. Vasc. Surg. N2 - OBJECTIVE: Upper extremity access (UEA) is an important component of complex fenestrated and branched endovascular aneurysm repair (F/BEVAR). Open and percutaneous UEA approaches have been reported during these procedures. The aim of this review was to assess the outcomes of UEA done to facilitate F/BEVAR. METHODS: A systematic review of studies focusing on upper extremity arterial access during F/BEVAR was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Three databases including PubMed MEDLINE, Embase, and Cochrane Library were queried. Outcomes of interest included UEA-related and other unrelated early and late morbidity and mortality, such as arterial occlusion, neurologic deficit, bleeding complications, and stroke, in patients undergoing UEA during F/BEVAR. RESULTS: Five full-text manuscripts and one abstract met criteria to be included, accounting for a total of 495 patients. The median age of patients who underwent UEA during F/BEVAR was 73.4 years. Predominantly male patients (371 [74.9%]) were treated. Indications for F/BEVAR were thoracoabdominal aortic aneurysms in 325 (65.6%), pararenal aneurysms in 96 (19.4%), juxtarenal aneurysms in 44 (8.9%), and suprarenal aortic aneurysms in 30 (6.1%). Axillary conduits were created in 29 (5.8%) patients. A total of 41 (8.2%) UEA-related complications were reported. Of those 41 complications, 17 (41.5%) were access bleeding, 10 (24.4%) were ischemic strokes, 7 (17.1%) were arterial occlusions, 4 (9.7%) were upper extremity neurologic deficits, 2 (4.9%) were arterial stenoses, and 1 (2.4%) was pseudoaneurysm. UEA-related complications were reported in 15 of 56 (26.8%) patients undergoing percutaneous UEA and 26 of 439 (5.9%) undergoing open UEA (P < .001). CONCLUSIONS: The overall complication rate associated with UEA during F/BEVAR is low, with 2% stroke rate reported. The percutaneous approach showed a higher UEA-related complication rate compared with open UEA. More studies on percutaneous UEA and randomized studies comparing open vs percutaneous UEA during F/BEVAR are warranted to determine the safest and most efficient UEA approach strategy during complex aortic procedures. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/31740188/A_systematic_review_of_outcomes_of_upper_extremity_access_for_fenestrated_and_branched_endovascular_aortic_repair L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(19)32362-6 DB - PRIME DP - Unbound Medicine ER -