A scoping review on the approaches for cannulation of reno-visceral target vessels during complex endovascular aortic repair

Abstract

OBJECTIVE To assess the approaches to reno-visceral target vessels (TV) cannulation during complex endovascular aortic repair (B/FEVAR), determine the evidence base that links these approaches to clinical outcomes, and identify literature gaps. METHODS A scoping review following the PRISMA Protocols Extension for Scoping Reviews was performed. Available full-text studies published in English (PubMed, Cochrane and EMBASE databases; last queried, 31 June 2022) were systematically reviewed and analyzed. Data were reported as descriptive narrative or tables, without any statistical analysis nor quality assessment. RESULTS Fourteen retrospective articles were included. Seven articles studied the use of upper extremity access (UEA) during B/FEVAR, three the use of steerable sheaths, and four included both approaches. A left UEA was used in 757 patients (technical success: 99%, stroke rate: 1–3%) and a right UEA in 215 patients (technical success: 92–98%, stroke rate: 0–13%). Seven studies (1066 patients) described a surgical access only (technical success: 80–99%, stroke rate: 0–13%), while three studies (146 patients) described a percutaneous access only (technical success: 83–90%, stroke rate: 3%), and lastly four studies compared UEA versus use of steerable sheaths from the transfemoral approach (TFA) (UEA: 563 patients, technical success: 95–98%, stroke rate: 1–8%; TFA: 209 patients, technical success: 98–100%, stroke rate: 0–1%). CONCLUSIONS Both UEA and TFA as cannulation approaches were associated with high technical success and low peri-operative complications. Currently, there is a paucity of high-quality data to provide definitive indication. Optimal UEA in terms of side (left vs right) and approach (surgical vs percutaneous) needs further study.

A review on the use of steerable sheaths in complex endovascular aortic repair

“…1 The risk can be reduced by an early removal of main graft, the use of preloaded stent grafts, and downsizing the TF access. 20 During a total TF approach, the main body of the endograft needs to be completely deployed before serial cannulation of TVVs become feasible. This reduces the manoeuvrability and manipulation of the main body which can be a problem if the fenestrations or branches are not aligned.…”

“…This can also lead to reperfusion injury, reduced spinal cord perfusion, and also pelvic ischemia 1 . The risk can be reduced by an early removal of main graft, the use of preloaded stent grafts, and downsizing the TF access 20 …”

“…The overall technical success rate in cannulating and bridge stenting of TVVs is high when using a steerable sheath and ranges from 98% to 100%. 9,20,22 In a review of 1681 patients who have undergone fenestrated-branched endovascular aneurysm repair, access from the upper extremity and TF approach were used in 67% and 33%, respectively. All TF approach required the use of a steerable sheath to catheterise the TVVs in an antegrade fashion.…”

“…Percutaneous access was associated with a haematoma rate of 0% to 12% and nerve injury rate of 0% to 5%. 20…”

“…Open access was associated with a haematoma rate of 0% to 3% and a nerve injury rate of 0% to 3%. Percutaneous access was associated with a haematoma rate of 0% to 12% and nerve injury rate of 0% to 5% 20 …”