Lateral Axillary Exposure for Antegrade Access during Endovascular Repair of Complex Abdominal Aortic and Thoracoabdominal Aneurysms

Autor: Travis G. Hughes, David J. Minion, Jeremy C. Miller, Abigail H. Clark, Jacob Hubbuch, Roberto G. Aru, Sam Tyagi, Michael C. Bounds
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Time Factors
Ischemia
Punctures
030204 cardiovascular system & hematology
Prosthesis Design
030218 nuclear medicine & medical imaging
Blood Vessel Prosthesis Implantation
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Hematoma
Axillary artery
medicine.artery
Catheterization
Peripheral
medicine
Brachial vein
Humans
cardiovascular diseases
Endovascular treatment
Aged
Retrospective Studies
Aged
80 and over
Aortic Aneurysm
Thoracic
business.industry
Endovascular Procedures
General Medicine
Middle Aged
medicine.disease
Thrombosis
Blood Vessel Prosthesis
Surgery
Lateral border
Treatment Outcome
Pectoralis Minor
cardiovascular system
Axillary Artery
Female
Stents
Cardiology and Cardiovascular Medicine
business
Aortic Aneurysm
Abdominal
Zdroj: Annals of Vascular Surgery. 74:176-181
ISSN: 0890-5096
DOI: 10.1016/j.avsg.2020.12.029
Popis: Background During endovascular treatment of pararenal aortic aneurysms (PAA) and thoracoabdominal aortic aneurysms (TAAA), our antegrade vascular access of choice is a lateral axillary exposure (LAE). We directly access the axillary artery with multiple sheaths followed by primary closure of the axillary artery at case completion. The aim of this study is to describe our technique and to report our results with this approach. Methods This study is a single-institution, retrospective review of 53 patients who were treated with parallel grafts for endovascular repair of PAA and TAAA from 2006 to 2018. The aortic repairs requiring LAE included: 9 cases of endo-leaks from prior endovascular repair, 20 TAAAs, and 24 PAAs. The axillary artery was exposed with a vertical axillary skin incision followed by retraction of the lateral border of the pectoralis major to expose the axillary artery distal to the pectoralis minor. A 5-French (F) through 12F sheaths were used to directly access the axillary artery for delivery of endovascular devices. Results Two hundred and sixty reno-visceral stents were delivered through 125 axillary sheaths in an antegrade fashion to 114 arteries without intraoperative complications or technical failures. Two postoperative complications included an access-site hematoma managed conservatively (1.9%) and a left brachial vein thrombosis treated with anticoagulation (1.9%). There were no cases of cerebrovascular or peripheral neurologic events, upper extremity ischemia, or reoperation related to LAE. Conclusions LAE is a valid approach for upper extremity access during the endovascular repair of complex aortic aneurysms requiring simultaneous delivery of multiple reno-visceral devices. It does not require the use of a prosthetic conduit. There were no neurologic events or upper extremity ischemia in our series.
Databáze: OpenAIRE
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