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

Max M. Meertens, Charlotte C. Lemmens, Gustavo S. Oderich, Geert W.H. Schurink, Barend M.E. Mees

Research output: Contribution to journalReview article

Abstract

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. Meta-analysis 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 meta-analysis, 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.

Original languageEnglish (US)
JournalCardioVascular and Interventional Radiology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Upper Extremity
Meta-Analysis
Aortic Aneurysm
Confidence Intervals
Library Science
Public Sector
Patient Rights
Therapeutics
Guidelines

Keywords

  • Access complications
  • Cerebrovascular events
  • Complex EVAR
  • Meta-analysis
  • Systematic Review
  • Upper extremity access

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions : A Systematic Review and Meta-Analysis. / Meertens, Max M.; Lemmens, Charlotte C.; Oderich, Gustavo S.; Schurink, Geert W.H.; Mees, Barend M.E.

In: CardioVascular and Interventional Radiology, 01.01.2019.

Research output: Contribution to journalReview article

@article{3dbeb74ae8b74d5287f983a2c7714468,
title = "Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions: A Systematic Review and Meta-Analysis",
abstract = "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. Meta-analysis 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 meta-analysis, 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.",
keywords = "Access complications, Cerebrovascular events, Complex EVAR, Meta-analysis, Systematic Review, Upper extremity access",
author = "Meertens, {Max M.} and Lemmens, {Charlotte C.} and Oderich, {Gustavo S.} and Schurink, {Geert W.H.} and Mees, {Barend M.E.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00270-019-02330-6",
language = "English (US)",
journal = "CardioVascular and Interventional Radiology",
issn = "7415-5101",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions

T2 - A Systematic Review and Meta-Analysis

AU - Meertens, Max M.

AU - Lemmens, Charlotte C.

AU - Oderich, Gustavo S.

AU - Schurink, Geert W.H.

AU - Mees, Barend M.E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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. Meta-analysis 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 meta-analysis, 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.

AB - 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. Meta-analysis 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 meta-analysis, 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.

KW - Access complications

KW - Cerebrovascular events

KW - Complex EVAR

KW - Meta-analysis

KW - Systematic Review

KW - Upper extremity access

UR - http://www.scopus.com/inward/record.url?scp=85074598246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074598246&partnerID=8YFLogxK

U2 - 10.1007/s00270-019-02330-6

DO - 10.1007/s00270-019-02330-6

M3 - Review article

C2 - 31591688

AN - SCOPUS:85074598246

JO - CardioVascular and Interventional Radiology

JF - CardioVascular and Interventional Radiology

SN - 7415-5101

ER -