A Single Center Review of a Total Transfemoral Approach to Upper Extremity Access in Branched and Fenestrated Physician Modified Endografts

Patel, Rohini J.; Mathlouthi, Asma; Al-Nouri, Omar; Lane, John S.; Malas, Mahmoud B.; Barleben, Andrew

doi:10.1016/j.avsg.2022.05.041

Cited by 4 publications

(15 citation statements)

References 39 publications

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“…This finding has also been demonstrated in several other studies 14,16–18,20 . Hauck et al and other studies also reported no difference in the risk of access site complications between the two groups 14,17,18 . However, another study by Plotkin et al showed a higher rate of access site occlusion in the UEA group than that in the TFA group.…”

Section: Discussionsupporting

confidence: 72%

“…Five studies reported the technical success rates in the TFA and UEA groups 14,16–18,20 . However, the analysis revealed no significant difference between the groups [97.52% versus 96.37%; RR:1.01; 95% CI:0.99–1.03; p = 0.23; I2 = 0%] (Figure 2B).…”

Section: Resultsmentioning

confidence: 99%

“…High heterogeneity was detected among the studies, for which a leave‐one‐out sensitivity analysis by Knowles et al was performed, which reduced heterogeneity to 0%. Five studies reported the duration of hospital stay (in days) as an outcome 14,15,17,19,20 . The duration of hospital stay was shorter in the TFA group than in the UEA group; however, these findings were not statistically significant [SMD, −0.20; 95% CI: −0.53 to 0.12; p = 0.22; I2 = 77%] (Figure 2I).…”

Section: Resultsmentioning

confidence: 99%

“…All studies [14][15][16][17][18][19][20][21] reported the operative time required in the TFA and UEA groups, and the time was significantly lower in the TFA group [SMD: −1.40; 95% CI: −1.82 to −0.97; p < 0.00001; I2 = 97%] (Figure 2G). High heterogeneity was observed among the studies for which we performed leave-one-out sensitivity analysis, which failed to reduce heterogeneity.…”

Section: Secondary Endpointsmentioning

confidence: 99%

“…were excluded. All studies [14][15][16][17][18][19][20][21] included reported fluoroscopy time as an outcome. Fluoroscopy time (in minutes) was significantly shorter in the TFA group than in the UEA group [SMD, −0.62; 95% CI: −1.00 to −0.24; p = 0.001; I2 = 97%] (Figure 2K).…”

Section: Secondary Endpointsmentioning

confidence: 99%

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Comparison between the outcomes of transfemoral access and transfemoral access with adjunct upper extremity access in patients undergoing endovascular aortic repair: A pilot systematic review and meta‐analysis

Goyal,

Fatima,

Mushtaq

et al. 2024

Cathet Cardio Intervent

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Endovascular aortic repair is an emerging novel intervention for the management of abdominal aortic aneurysms. It is crucial to compare the effectiveness of different access sites, such as transfemoral access (TFA) and upper extremity access (UEA). An electronic literature search was conducted using PubMed, EMBASE, and Google Scholar databases. The primary endpoint was the incidence of stroke/transient ischemic attack (TIA), while the secondary endpoints included technical success, access‐site complications, mortality, myocardial infarction (MI), spinal cord ischemia, among others. Forest plots were constructed for the pooled analysis of data using the random‐effects model in Review Manager, version 5.4. Statistical significance was set at p < 0.05. Our findings in 9403 study participants (6228 in the TFA group and 3175 in the UEA group) indicate that TFA is associated with a lower risk of stroke/TIA [RR: 0.55; 95% CI: 0.40–0.75; p = 0.0002], MI [RR: 0.51; 95% CI: 0.38–0.69; p < 0.0001], spinal cord ischemia [RR: 0.41; 95% CI: 0.32–0.53, p < 0.00001], and shortens fluoroscopy time [SMD: −0.62; 95% CI: −1.00 to −0.24; p = 0.001]. Moreover, TFA required less contrast agent [SMD: −0.33; 95% CI: −0.61 to −0.06; p = 0.02], contributing to its appeal. However, no significant differences emerged in technical success [p = 0.23], 30‐day mortality [p = 0.48], ICU stay duration [p = 0.09], or overall hospital stay length [p = 0.22]. Patients with TFA had a lower risk of stroke, MI, and spinal cord ischemia, shorter fluoroscopy time, and lower use of contrast agents. Future large‐scale randomized controlled trials are warranted to confirm and strengthen these findings.

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Section: Discussionsupporting

confidence: 72%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%