Universität zu Köln

Meertens, Max M., van Herwaarden, Joost A., de Vries, Jean Paul P. M., Verhagen, Hence J. M., van der Laan, Maarten J., Reijnen, Michel M. P. J., Schurink, Geert W. H. and Mees, Barend M. E. (2022). Multicenter experience of upper extremity access in complex endovascular aortic aneurysm repair. J. Vasc. Surg., 76 (5). S. 1150 - 1160. NEW YORK: MOSBY-ELSEVIER. ISSN 1097-6809

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Abstract

Purpose: Upper extremity access (UEA) for antegrade cannulation of aortic side branches is a relevant part of endovascular treatment of complex aortic aneurysms and can be achieved using several techniques, sites, and sides. The purpose of this study was to evaluate different UEA strategies in a multicenter registry of complex endovascular aortic aneurysm repair (EVAR). Methods: In six aortic centers in the Netherlands, all endovascular aortic procedures from 2006 to 2019 were retrospectively reviewed. Patients who received UEA during complex EVAR were included. The primary outcome was a composite end point of any access complication, excluding minor hematomas. Secondary outcomes were access characteristics, access complications considered individually, access reinterventions, and incidence of ischemic cerebrovascular events. Results: A total of 417 patients underwent 437 UEA for 303 fenestrated/branched EVARs and 114 chimney EVARs. Twenty patients had bilateral, 295 left-sided, and 102 right-sided UEA. A total of 413 approaches were performed surgically and 24 percutaneously. Distal brachial access (DBA) was used in 89 cases, medial brachial access (MBA) in 149, proximal brachial access (PBA) in 140, and axillary access (AA) in 59 cases. No significant differences regarding the composite end point of access complications were seen (DBA: 11.3% vs MBA: 6.7% vs PBA: 13.6% vs AA: 10.2%; P = .29). Postoperative neuropathy occurred most after PBA (DBA: 1.1% vs MBA: 1.3% vs PBA: 9.3% vs AA: 5.1%; P = .003). There were no differences in cerebrovascular complications between access sides (right: 5.9% vs left: 4.1% vs bilateral: 5%; P = .75). Significantly more overall access complications were seen after a percutaneous approach (29.2% vs 6.8%; P = .002). In multivariate analysis, the risk for access complications after an open approach was decreased by male sex (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.10-0.72; P = .009), whereas an increase in age per year (OR: 1.08; 95% CI: 1.004-1.179; P = .039) and diabetes mellitus type 2 (OR: 3.70; 95% CI: 1.20-11.41; P = .023) increased the risk. Conclusions: Between the four access localizations, there were no differences in overall access complications. Female sex, diabetes mellitus type 2, and aging increased the risk for access complications after a surgical approach. Furthermore, a percutaneous UEA resulted in higher complication rates than a surgical approach.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Meertens, Max M. UNSPECIFIED UNSPECIFIED UNSPECIFIED van Herwaarden, Joost A. UNSPECIFIED UNSPECIFIED UNSPECIFIED de Vries, Jean Paul P. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Verhagen, Hence J. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED van der Laan, Maarten J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Reijnen, Michel M. P. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schurink, Geert W. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mees, Barend M. E. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-691757
DOI:	10.1016/j.jvs.2022.04.055
Journal or Publication Title:	J. Vasc. Surg.
Volume:	76
Number:	5
Page Range:	S. 1150 - 1160
Date:	2022
Publisher:	MOSBY-ELSEVIER
Place of Publication:	NEW YORK
ISSN:	1097-6809
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language VALVE IMPLANTATION; PERCUTANEOUS ACCESS; CHIMNEY TECHNIQUE; BRACHIAL ACCESS; ARTERY ACCESS; COMPLICATIONS; BRANCHES; SAFE Multiple languages Surgery; Peripheral Vascular Disease Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69175