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Outcomes of Upper Extremity Access with Surgical Exposure of the Axillary Artery in Fenestrated and Branched Endovascular Aneurysm Repair

Published:August 09, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.07.052

      Objective

      This study aims to assess the safety of upper extremity access with surgical exposure of the axillary artery in fenestrated and branched endovascular aneurysm repair (F/B-EVAR), evaluating neurological and local complications as well as re-interventions associated with the technique.

      Methods

      All patients undergoing an F/B-EVAR procedure with surgical exposure of the axillary artery between January 2010 and March 2020 were included in this retrospective single centre study. Endpoints were neurological and access related complications and re-interventions related to the upper extremity access. Complications related to the technique included stroke/transient ischaemic attack, wound infection, peripheral nerve injury, and arterial complications.

      Results

      264 patients (192 male, mean age 70 ± 7 years) were included. Upper extremity access was performed over the left axillary artery in 257 (97%) of the cases, and over the right axillary artery in the remaining seven cases. Six (2.2%) patients had early complications related to the arterial access: four with post-operative bleeding and two with acute arm ischaemia. Two patients with post-operative bleeding and both patients with ischaemic complications required re-intervention. One of these patients with arm ischaemia died five weeks after the re-intervention due to sepsis complications related to patch infection. Sixteen (6%) patients presented with transient arm paraesthesia or sensory neurological deficit post-operatively. The symptoms completely recovered in all cases with no residual deficits. Peri-operative ischaemic stroke occurred in three (1%) patients (two minor, one major). No other access related complications were recorded during follow up in any of the patients with no cases of late stenosis/occlusion.

      Conclusion

      Upper extremity access with surgical exposure of the axillary artery is a safe method for antegrade catheterisation of fenestrations and branches in complex endovascular aneurysm repair.

      Keywords

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      References

        • Eagleton M.J.
        • Follansbee M.
        • Wolski K.
        • Mastracci T.
        • Kuramochi Y.
        Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms.
        J Vasc Surg. 2016; 63: 930-942
        • Van Calster K.
        • Bianchini A.
        • Elias F.
        • Hertault A.
        • Azzaoui R.
        • Fabre D.
        • et al.
        Risk factors for early and late mortality after fenestrated and branched endovascular repair of complex aneurysms.
        J Vasc Surg. 2019; 69: 1342-1355
        • Verhoeven E.L.
        • Katsargyris A.
        • Bekkema F.
        • Oikonomou K.
        • Zeebregts C.J.
        • Ritter W.
        • et al.
        Editor’s Choice – Ten-year experience with endovascular repair of thoracoabdominal aortic aneurysms: results from 166 consecutive patients.
        Eur J Vasc Endovasc Surg. 2015; 49: 524-531
        • Mirza A.K.
        • Oderich G.S.
        • Sandri G.A.
        • Tenorio E.R.
        • Davila V.J.
        • Kärkkäinen J.M.
        • et al.
        Outcomes of upper extremity access during fenestrated-branched endovascular aortic repair.
        J Vasc Surg. 2019; 69: 635-643
        • Fiorucci B.
        • Kölbel T.
        • Rohlffs F.
        • Heidemann F.
        • Debus S.E.
        • Tsilimparis N.
        Right brachial access is safe for branched endovascular aneurysm repair in complex aortic disease.
        J Vasc Surg. 2017; 66: 360-366
        • Malgor R.D.
        • Marques de Marino P.
        • Verhoeven E.
        • Katsargyris A.
        A systematic review of outcomes of upper extremity access for fenestrated and branched endovascular aortic repair.
        J Vasc Surg. 2020; 71: 1763-1770
        • Lavingia K.S.
        • Dua A.
        • Stern J.R.
        Upper extremity access options for complex endovascular aortic interventions.
        J Cardiovasc Surg (Torino). 2018; 59: 360-367
        • Harris E.
        • Warner C.J.
        • Hnath J.C.
        • Sternbach Y.
        • Darling 3rd, R.C.
        Percutaneous axillary artery access for endovascular interventions.
        J Vasc Surg. 2018; 68: 555-559
        • Bertoglio L.
        • Grandi A.
        • Melloni A.
        • Kahlberg A.
        • Melissano G.
        • Chiesa R.
        Percutaneous AXillary Artery (PAXA) Access at the first segment during fenestrated and branched endovascular aortic procedures.
        Eur J Vasc Endovasc Surg. 2020; 59: 929-938
        • Bertoglio L.
        • Mascia D.
        • Cambiaghi T.
        • Kahlberg A.
        • Melissano G.
        • Chiesa R.
        Percutaneous axillary artery access for fenestrated and branched thoracoabdominal endovascular repair.
        J Vasc Surg. 2018; 68: 12-23
        • Branzan D.
        • Steiner S.
        • Haensig M.
        • Scheinert D.
        • Schmidt A.
        Percutaneous axillary artery access for endovascular treatment of complex thoraco-abdominal aortic aneurysms.
        Eur J Vasc Endovasc Surg. 2019; 58: 344-349
        • Makaloski V.
        • Tsilimparis N.
        • Rohlffs F.
        Use of a steerable sheath for retrograde access to antegrade branches in branched stent-graft repair of complex aortic aneurysms.
        J Endovasc Ther. 2018; 25: 566-570
        • Eilenberg W.
        • Kölbel T.
        • Rohlffs F.
        • Oderich G.
        • Eleshra A.
        • Tsilimparis N.
        • et al.
        Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair.
        J Vasc Surg. 2021; 73: 1498-1503
        • Katsargyris A.
        • Marques de Marino P.
        • Mufty H.
        • Pedro L.M.
        • Fernandes R.
        • Verhoeven E.L.G.
        Early experience with the use of inner branches in endovascular repair of complex abdominal and thoraco-abdominal aortic aneurysms.
        Eur J Vasc Endovasc Surg. 2018; 55: 640-646
        • Verhoeven E.L.G.
        • Marques de Marino P.
        • Katsargyris A.
        Increasing role of fenestrated and branched endoluminal techniques in the thoracoabdominal segment including supra- and pararenal AAA.
        Cardiovasc Intervent Radiol. 2020; 43: 1779-1787
        • Katsargyris A.
        • Marques de Marino P.
        • Verhoeven E.L.
        Graft design and selection of fenestrations vs. branches for renal and mesenteric incorporation in endovascular treatment of pararenal and thoracoabdominal aortic aneurysms.
        J Cardiovasc Surg (Torino). 2019; 60: 35-40
        • von Allmen R.S.
        • Weiss S.
        • Tevaearai H.T.
        • Kuemmerli C.
        • Tinner C.
        • Carrel T.P.
        • et al.
        Completeness of follow-up determines validity of study findings: results of a prospective repeated measures cohort study.
        PLoS one. 2015; 10e0140817
        • Motta F.
        • Crowner J.R.
        • Kalbaugh C.A.
        • Knowles M.
        • Pascarella L.
        • McGinigle K.L.
        • et al.
        Stenting of superior mesenteric and celiac arteries does not increase complication rates after fenestrated-branched endovascular aneurysm repair.
        J Vasc Surg. 2019; 70: 691-701
        • Sveinsson M.
        • Sobocinski J.
        • Resch T.
        • Sonesson B.
        • Dias N.
        • Haulon S.
        • et al.
        Early versus late experience in fenestrated endovascular repair for abdominal aortic aneurysm.
        J Vasc Surg. 2015; 61: 895-901
        • Mastracci T.M.
        • Greenberg R.K.
        • Eagleton M.J.
        • Hernandez A.V.
        Durability of branches in branched and fenestrated endografts.
        J Vasc Surg. 2013; 57: 926-933
        • Swerdlow N.J.
        • Liang P.
        • Li C.
        • Dansey K.
        • O’Donnell T.F.X.
        • de Guerre L.
        • et al.
        Stroke rate after endovascular aortic interventions in the Society for Vascular Surgery Vascular Quality Initiative.
        J Vasc Surg. 2020; 72: 1593-1601
        • Katsargyris A.
        • Oikonomou K.
        • Klonaris C.
        • Topel I.
        • Verhoeven E.L.
        Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift?.
        J Endovasc Ther. 2013; 20: 159-169
        • Buth J.
        • Harris P.L.
        • Hobo R.
        • van Eps R.
        • Cuypers P.
        • Duijm L.
        • et al.
        Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry.
        J Vasc Surg. 2007; 46: 1103-1110
        • von Allmen R.S.
        • Gahl B.
        • Powell J.T.
        Editor’s Choice – Incidence of stroke following thoracic endovascular aortic repair for descending aortic aneurysm: a systematic review of the literature with meta-analysis.
        Eur J Vasc Endovasc Surg. 2017; 53: 176-184
        • Coscas R.
        • Kobeiter H.
        • Desgranges P.
        • Becquemin J.P.
        Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms.
        J Vasc Surg. 2011; 53: 1520-1527
        • Lee J.T.
        • Greenberg J.I.
        • Dalman R.L.
        Early experience with the snorkel technique for juxtarenal aneurysms.
        J Vasc Surg. 2012; 55: 935-946
        • Scott C.K.
        • Driessen A.L.
        • Gonzalez M.S.
        • Malekpour F.
        • Guardiola G.G.
        • Baig M.S.
        • et al.
        Perioperative neurologic outcomes of right versus left upper extremity access for fenestrated-branched endovascular aortic aneurysm repair.
        J Vasc Surg. 2022; 75: 794-802
        • Mirza A.K.
        • Tenorio E.R.
        Comparison of cerebral embolic events between right and left upper extremity access during fenestrated/branched endovascular aortic repair.
        J Endovasc Ther. 2021; 28: 70-77
        • Maximus S.
        • Long K.
        • Babrowski T.
        • Park J.
        • Milner R.
        Right-sided upper extremity access for patients undergoing parallel graft placement during endovascular aortic repair is not associated with increased neurologic events when compared with left upper extremity access.
        Ann Vasc Surg. 2021; 73: 37-42
        • Knowles M.
        • Nation D.A.
        • Timaran D.E.
        • Gomez L.F.
        • Baig M.S.
        • Valentine R.J.
        • et al.
        Upper extremity access for fenestrated endovascular aortic aneurysm repair is not associated with increased morbidity.
        J Vasc Surg. 2015; 61: 80-87
        • Yufa A.
        • Mikael A.
        • Gautier G.
        • Yoo J.
        • Vo T.D.
        • Tayyarah M.
        • et al.
        Percutaneous axillary artery access for peripheral and complex endovascular interventions: clinical outcomes and cost benefits.
        Ann Vasc Surg. 2022; 83: 176-183
        • Agrusa C.J.
        • Connolly P.H.
        • Ellozy S.H.
        • Schneider D.B.
        Safety and effectiveness of percutaneous axillary artery access for complex aortic interventions.
        Ann Vasc Surg. 2019; 61: 326-333
        • Kirkwood M.L.
        • Guild J.B.
        • Arbique G.M.
        • Anderson J.A.
        • Valentine R.J.
        • Timaran C.
        Surgeon radiation dose during complex endovascular procedures.
        J Vasc Surg. 2015; 62: 457-463
        • Hertault A.
        • Maurel B.
        • Midulla M.
        • Bordier C.
        • Desponds L.
        • Saeed Kilani M.
        • et al.
        Editor’s Choice – Minimising radiation exposure during endovascular procedures: basic knowledge, literature review, and reporting standards.
        Eur J Vasc Endovasc Surg. 2015; 50: 21-36

      Linked Article

      • We Can Go Up, and We Can Go Down, But Does It Really Matter Anyway?
        European Journal of Vascular and Endovascular SurgeryVol. 64Issue 4
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          Catheterisation of downward directional branches and target vessels represents a major technical challenge when performing fenestrated and branched endovascular repair (F/B-EVAR) of thoraco-abdominal aortic aneurysms (TAAAs). Multiple methods for accessing these vessels are currently employed, including percutaneous and surgical approaches to the axillary/brachial arteries, as well as cannulation from a femoral approach using directional sheaths.
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