Outcomes of upper extremity during fenestrated-branched endovascular aortic repair

Aleem K. Mirza, Gustavo Oderich, Giuliano A. Sandri, Emanuel R. Tenorio, Victor J. Davila, Jussi M. Kärkkäinen, Jan Hofer, Stephan Cha

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: Upper extremity (UE) access is frequently used during fenestrated-branched endovascular aortic repair (F-BEVAR) to facilitate catheterization of downgoing vessels. Limitations include risk of cerebral embolization and of UE arterial or peripheral nerve injury. The aim of this study was to assess outcomes of F-BEVAR using UE access. Methods: We reviewed the clinical data of 334 consecutive patients (74% males; mean age 75 ± 8 years) treated by F-BEVAR for thoracoabdominal aortic aneurysms or pararenal aortic aneurysms between 2007 and 2016. Patients who underwent F-BEVAR with an UE approach for catheterization of the renal and/or mesenteric arteries were included in the study. End points were technical success, mortality, and a composite of access-related complications including cerebral embolization (stroke/transient ischemic attack), peripheral nerve injury, and axillary-brachial arterial complications requiring intervention. Results: There were 243 patients (73%) treated by F-BEVAR with UE access, including 147 patients (60%) with thoracoabdominal aortic aneurysms and 96 patients (40%) with pararenal aortic aneurysms. A total of 878 renal–mesenteric arteries were incorporated by fenestrations or branches with a mean of 3.6 ± 0.8 vessels per patient. All patients had surgical exposure of the brachial artery. The left side was selected in 228 (94%) and the right side in 15 (6%). The technical success of target vessel incorporation was achieved in 99% of patients (870 of 878). Arterial closure was performed using primary repair in 213 patients (88%) or bovine patch angioplasty in 29 (12%). Patch closure was required in 13% of patients (21 of 159) treated by 10- to 12F sheaths and 8% (7 of 83) of those who had 7- to 8F sheaths (P =.19). There were six deaths (2.5%) at 30 days or within the hospital stay, none owing to access-related complications. Major access-related complication occurred in eight patients (3%), with no difference between the 10- to 12F (6 of 159 [4%]) or 7- to 8F sheaths (2 of 83 [2%]; P =.45). Two patients (1%) had transient median nerve neuropraxia, which resolved within 1 year. One patient (0.5%) required surgical evacuation of an access site hematoma. There were no UE arterial pseudoaneurysms, occlusions, or distal embolizations. Five patients (2%) had strokes (three minor, two major), occurring more frequently with right side (2 of 15 [13%]) as compared with left-sided access (3 of 228 [1%]; P =.03). After a mean follow-up of 38 ± 15 months, there were no other access-related complications or reinterventions. Conclusions: UE arterial access with surgical exposure was associated with a low rate of complications in patients treated with F-BEVAR. Closure with patch angioplasty is frequently needed, but there were no arterial occlusions, pseudoaneurysms, or distal embolizations requiring secondary procedures.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Upper Extremity
Thoracic Aortic Aneurysm
Peripheral Nerve Injuries
Aortic Aneurysm
False Aneurysm
Angioplasty
Catheterization
Stroke
Mesenteric Arteries
Brachial Artery
Median Nerve
Transient Ischemic Attack
Renal Artery
Hematoma
Length of Stay
Arm
Arteries

Keywords

  • Cerebral embolization
  • F-BEVAR
  • Upper extremity

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Mirza, A. K., Oderich, G., Sandri, G. A., Tenorio, E. R., Davila, V. J., Kärkkäinen, J. M., ... Cha, S. (Accepted/In press). Outcomes of upper extremity during fenestrated-branched endovascular aortic repair. Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2018.05.214

Outcomes of upper extremity during fenestrated-branched endovascular aortic repair. / Mirza, Aleem K.; Oderich, Gustavo; Sandri, Giuliano A.; Tenorio, Emanuel R.; Davila, Victor J.; Kärkkäinen, Jussi M.; Hofer, Jan; Cha, Stephan.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Mirza, Aleem K. ; Oderich, Gustavo ; Sandri, Giuliano A. ; Tenorio, Emanuel R. ; Davila, Victor J. ; Kärkkäinen, Jussi M. ; Hofer, Jan ; Cha, Stephan. / Outcomes of upper extremity during fenestrated-branched endovascular aortic repair. In: Journal of Vascular Surgery. 2018.
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abstract = "Objective: Upper extremity (UE) access is frequently used during fenestrated-branched endovascular aortic repair (F-BEVAR) to facilitate catheterization of downgoing vessels. Limitations include risk of cerebral embolization and of UE arterial or peripheral nerve injury. The aim of this study was to assess outcomes of F-BEVAR using UE access. Methods: We reviewed the clinical data of 334 consecutive patients (74{\%} males; mean age 75 ± 8 years) treated by F-BEVAR for thoracoabdominal aortic aneurysms or pararenal aortic aneurysms between 2007 and 2016. Patients who underwent F-BEVAR with an UE approach for catheterization of the renal and/or mesenteric arteries were included in the study. End points were technical success, mortality, and a composite of access-related complications including cerebral embolization (stroke/transient ischemic attack), peripheral nerve injury, and axillary-brachial arterial complications requiring intervention. Results: There were 243 patients (73{\%}) treated by F-BEVAR with UE access, including 147 patients (60{\%}) with thoracoabdominal aortic aneurysms and 96 patients (40{\%}) with pararenal aortic aneurysms. A total of 878 renal–mesenteric arteries were incorporated by fenestrations or branches with a mean of 3.6 ± 0.8 vessels per patient. All patients had surgical exposure of the brachial artery. The left side was selected in 228 (94{\%}) and the right side in 15 (6{\%}). The technical success of target vessel incorporation was achieved in 99{\%} of patients (870 of 878). Arterial closure was performed using primary repair in 213 patients (88{\%}) or bovine patch angioplasty in 29 (12{\%}). Patch closure was required in 13{\%} of patients (21 of 159) treated by 10- to 12F sheaths and 8{\%} (7 of 83) of those who had 7- to 8F sheaths (P =.19). There were six deaths (2.5{\%}) at 30 days or within the hospital stay, none owing to access-related complications. Major access-related complication occurred in eight patients (3{\%}), with no difference between the 10- to 12F (6 of 159 [4{\%}]) or 7- to 8F sheaths (2 of 83 [2{\%}]; P =.45). Two patients (1{\%}) had transient median nerve neuropraxia, which resolved within 1 year. One patient (0.5{\%}) required surgical evacuation of an access site hematoma. There were no UE arterial pseudoaneurysms, occlusions, or distal embolizations. Five patients (2{\%}) had strokes (three minor, two major), occurring more frequently with right side (2 of 15 [13{\%}]) as compared with left-sided access (3 of 228 [1{\%}]; P =.03). After a mean follow-up of 38 ± 15 months, there were no other access-related complications or reinterventions. Conclusions: UE arterial access with surgical exposure was associated with a low rate of complications in patients treated with F-BEVAR. Closure with patch angioplasty is frequently needed, but there were no arterial occlusions, pseudoaneurysms, or distal embolizations requiring secondary procedures.",
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TY - JOUR

T1 - Outcomes of upper extremity during fenestrated-branched endovascular aortic repair

AU - Mirza, Aleem K.

AU - Oderich, Gustavo

AU - Sandri, Giuliano A.

AU - Tenorio, Emanuel R.

AU - Davila, Victor J.

AU - Kärkkäinen, Jussi M.

AU - Hofer, Jan

AU - Cha, Stephan

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Upper extremity (UE) access is frequently used during fenestrated-branched endovascular aortic repair (F-BEVAR) to facilitate catheterization of downgoing vessels. Limitations include risk of cerebral embolization and of UE arterial or peripheral nerve injury. The aim of this study was to assess outcomes of F-BEVAR using UE access. Methods: We reviewed the clinical data of 334 consecutive patients (74% males; mean age 75 ± 8 years) treated by F-BEVAR for thoracoabdominal aortic aneurysms or pararenal aortic aneurysms between 2007 and 2016. Patients who underwent F-BEVAR with an UE approach for catheterization of the renal and/or mesenteric arteries were included in the study. End points were technical success, mortality, and a composite of access-related complications including cerebral embolization (stroke/transient ischemic attack), peripheral nerve injury, and axillary-brachial arterial complications requiring intervention. Results: There were 243 patients (73%) treated by F-BEVAR with UE access, including 147 patients (60%) with thoracoabdominal aortic aneurysms and 96 patients (40%) with pararenal aortic aneurysms. A total of 878 renal–mesenteric arteries were incorporated by fenestrations or branches with a mean of 3.6 ± 0.8 vessels per patient. All patients had surgical exposure of the brachial artery. The left side was selected in 228 (94%) and the right side in 15 (6%). The technical success of target vessel incorporation was achieved in 99% of patients (870 of 878). Arterial closure was performed using primary repair in 213 patients (88%) or bovine patch angioplasty in 29 (12%). Patch closure was required in 13% of patients (21 of 159) treated by 10- to 12F sheaths and 8% (7 of 83) of those who had 7- to 8F sheaths (P =.19). There were six deaths (2.5%) at 30 days or within the hospital stay, none owing to access-related complications. Major access-related complication occurred in eight patients (3%), with no difference between the 10- to 12F (6 of 159 [4%]) or 7- to 8F sheaths (2 of 83 [2%]; P =.45). Two patients (1%) had transient median nerve neuropraxia, which resolved within 1 year. One patient (0.5%) required surgical evacuation of an access site hematoma. There were no UE arterial pseudoaneurysms, occlusions, or distal embolizations. Five patients (2%) had strokes (three minor, two major), occurring more frequently with right side (2 of 15 [13%]) as compared with left-sided access (3 of 228 [1%]; P =.03). After a mean follow-up of 38 ± 15 months, there were no other access-related complications or reinterventions. Conclusions: UE arterial access with surgical exposure was associated with a low rate of complications in patients treated with F-BEVAR. Closure with patch angioplasty is frequently needed, but there were no arterial occlusions, pseudoaneurysms, or distal embolizations requiring secondary procedures.

AB - Objective: Upper extremity (UE) access is frequently used during fenestrated-branched endovascular aortic repair (F-BEVAR) to facilitate catheterization of downgoing vessels. Limitations include risk of cerebral embolization and of UE arterial or peripheral nerve injury. The aim of this study was to assess outcomes of F-BEVAR using UE access. Methods: We reviewed the clinical data of 334 consecutive patients (74% males; mean age 75 ± 8 years) treated by F-BEVAR for thoracoabdominal aortic aneurysms or pararenal aortic aneurysms between 2007 and 2016. Patients who underwent F-BEVAR with an UE approach for catheterization of the renal and/or mesenteric arteries were included in the study. End points were technical success, mortality, and a composite of access-related complications including cerebral embolization (stroke/transient ischemic attack), peripheral nerve injury, and axillary-brachial arterial complications requiring intervention. Results: There were 243 patients (73%) treated by F-BEVAR with UE access, including 147 patients (60%) with thoracoabdominal aortic aneurysms and 96 patients (40%) with pararenal aortic aneurysms. A total of 878 renal–mesenteric arteries were incorporated by fenestrations or branches with a mean of 3.6 ± 0.8 vessels per patient. All patients had surgical exposure of the brachial artery. The left side was selected in 228 (94%) and the right side in 15 (6%). The technical success of target vessel incorporation was achieved in 99% of patients (870 of 878). Arterial closure was performed using primary repair in 213 patients (88%) or bovine patch angioplasty in 29 (12%). Patch closure was required in 13% of patients (21 of 159) treated by 10- to 12F sheaths and 8% (7 of 83) of those who had 7- to 8F sheaths (P =.19). There were six deaths (2.5%) at 30 days or within the hospital stay, none owing to access-related complications. Major access-related complication occurred in eight patients (3%), with no difference between the 10- to 12F (6 of 159 [4%]) or 7- to 8F sheaths (2 of 83 [2%]; P =.45). Two patients (1%) had transient median nerve neuropraxia, which resolved within 1 year. One patient (0.5%) required surgical evacuation of an access site hematoma. There were no UE arterial pseudoaneurysms, occlusions, or distal embolizations. Five patients (2%) had strokes (three minor, two major), occurring more frequently with right side (2 of 15 [13%]) as compared with left-sided access (3 of 228 [1%]; P =.03). After a mean follow-up of 38 ± 15 months, there were no other access-related complications or reinterventions. Conclusions: UE arterial access with surgical exposure was associated with a low rate of complications in patients treated with F-BEVAR. Closure with patch angioplasty is frequently needed, but there were no arterial occlusions, pseudoaneurysms, or distal embolizations requiring secondary procedures.

KW - Cerebral embolization

KW - F-BEVAR

KW - Upper extremity

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