Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

Eilenberg, Wolf; Kölbel, Tilo; Rohlffs, Fiona; Oderich, Gustavo S.; Eleshra, Ahmed; Tsilimparis, Nikolaos; Debus, Sebastian; Panuccio, Giuseppe

doi:10.1016/j.jvs.2020.11.020

Cited by 48 publications

(35 citation statements)

References 24 publications

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“…Apart from these direct advantages, other studies have reported a lower rate of spinal cord ischemia and a lower rate of thromboembolic events as well as less lower leg ischemia including associated complications when using a transfemoral approach [ 14 , 19 , 20 ]. However, some of these findings are probably rather associated with a concomitant strategy of early removal of the large-caliber sheaths for the main body and exchange for a non-occlusive access to restore femoral blood flow early and minimize ischemia time.…”

Section: Discussionmentioning

confidence: 99%

“…Other examples of transfemoral bEVAR approach have been reported, among them a series of heterogeneous approaches of physician-modified sheath-in-sheath combinations with wires [ 14 ] and two case reports: one describing a successful implantation with the sheath reported here [ 21 ] and one using another commercially available steerable sheath (Destino, Oscor, Palm Harbor, USA) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, self-made or pre-manufactured steerable sheaths have been utilized to catheterize downward facing branches from a femoral access [ 14 , 16 ]. One cohort study reported favorable outcomes for a heterogenous mixture of different physician-modified devices for femoral access in bEVAR, including adjunct techniques such as occlusion balloons, external pull-through wires and sheath-in-sheath constructions [ 14 ]. The alternative, commercially available modern large-caliber steerable sheaths have only been mentioned in case reports [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Hauck

Eilenberg

Kupferthaler

et al. 2022

Cardiovasc Intervent Radiol

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Purpose To compare bridging stent graft (BSG) implantation in downward oriented branches in branched endovascular aortic repair (bEVAR), using a commercially available steerable sheath from an exclusively femoral access (TFA) with traditional upper extremity access (UEA). Methods In a retrospective cohort study, 7 patients with 19 branches in the TFA cohort received BSG insertion using the Medtronic Heli FX steerable sheath from a femoral access, and 10 patients with 32 branches in the UEA cohort from a brachial approach. Technical success, total intervention time, fluoroscopy time, branch cannulation time, and complication rate were recorded. Results Technical success was 19/19 branches in the TFA and 31/32 in the UEA cohort. The mean branch cannulation time was considerably shorter in the TFA group (17 vs. 29 min, p = 0.003), and total intervention time tended to be shorter (169 vs. 217 min, p = 0.176). Conclusion Using a commercially available steerable sheath allowed successful cannulation of all branches in this cohort and was associated with significantly shorter branch cannulation times. Potentially, this technique can lower the stroke and brachial puncture site complication risk as well as reduce total intervention time and radiation dose. Level of Evidence 2b, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Hauck

Eilenberg

Kupferthaler

et al. 2022

Cardiovasc Intervent Radiol

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“…2 To overcome these problems, cannulation of the branches (in both inner and outer branch designs) from femoral access using steerable sheaths has been used and described previously. 3,4 In addition, to simplify the cannulation, preloaded wires in the branches have been implemented by different manufacturers similar to the application of preloaded wires in fenestrated endovascular aneurysm repair (fEVAR). Disadvantage of the precannulated technique is the mandatory axillary approach.…”

Section: Introductionmentioning

confidence: 99%

Retrograde Approach for Antegrade Inner Branches in a Precannulated Off-the-Shelf Multibranch Device

2021

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Purpose: The purpose of this technical note was to describe the application of the combination of precannulated branches and a femoral approach for bridging stent graft deployment in branched endovascular aneurysm repair. Technique: The technique is shown in a 65-year-old woman treated for thoracoabdominal aneurysm type I with endovascular repair using a multibranched device. The stent graft is an off-the-shelf device with 4 precannulated inner branches. Access to the precannulated branches is gained using a steerable sheath from retrograde femoral access instead of using access via the upper extremities. For this purpose, a 0.018ʺ wire introduced to the precannulated tube is snared into the steerable sheath. Next, the steerable sheath is guided into a stable position inside the branch. With this technique, the implantation of this off-the-shelf multibranch device could be completed safe and quickly with a full femoral approach avoiding upper extremity access. Conclusion: The combination of a precannulated multibranch stent graft with a full femoral approach for target vessel revascularisation is a feasible and quick method for complex endovascular repair.

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“…The take home message is that patients with claudication should receive aggressive risk factor modification before invasive treatment because symptom recurrence is high and is associated with poor medical optimization.The final article, by Eilenberg and co-authors from Hamburg, Germany and Rochester, Minnesota, is entitled "Comparison of transfemoral vs upper extremity access to antegrade branches in branched endovascular aortic repair." 4 The study compared outcomes in 60 patients with transfemoral access (TFA) vs 92 patients with upper extremity access used for branched endovascular aortic repair (BEVAR). Transfemoral access coupled with the preloaded wire technique was associated with lower rate of complications and a higher rate of technical success.…”

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confidence: 99%

Journal of Vascular Surgery – May 2021 Audiovisual Summary

Gloviczki¹

2021

Journal of Vascular Surgery

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As we go to the press today, on February 28, over 28 million people have tested positive for the COVID-19 virus in the U.S and over 512,000 have died. The COVID -19 collection of the JVS journals continues to grow and includes now more than 120 publications on COVID-19 and vascular disease.I am pleased to introduce the 2021 May issue of the Journal of Vascular Surgery and highlight four excellent papers, which are freely available for the next 2 months. Our Editors' Choice article for this issue is "Validation of the Global Limb Anatomic Staging System in first-time lower extremity revascularization," by Dr Liang and colleagues from Boston, Massachusetts. 1 This is a retrospective review of 1060 patients who had undergone 1180 first-time open or endovascular revascularizations for chronic limb threatening ischemia. Using the angiographic images, the limbs were classified according to the GLASS grading, published in the Global Vascular Guidelines. The grades from 0 to 4 are based on the length of the disease, the presence, length, and location of chronic total occlusion (CTO), and the extent of popliteal artery involvement in patients with femoropopliteal disease and according to the lengths and locations of the stenosis and of the CTO in patients with infrapopliteal disease. The main finding in this paper is that a higher GLASS stage was associated with greater rates of reintervention and restenosis and the take home message is that GLASS can be used to predict reintervention and restenosis after first-time lower extremity revascularization.Our CME article this month is titled "Comparison of open-and closed-cell stent design outcomes after carotid artery stenting in the Vascular Quality Initiative." 2 It was written by Dr Faateh and colleagues from Baltimore, Maryland and La Jolla, California. In this VQI study, carotid stenting with a distal protection device was performed using closed-cell stents in 1384 and open-cell stents in 1287 patients. There was no significant difference between the two groups in in-hospital mortality, stroke, and stroke/death. Patients who received closed cell stents, however, had increased odds of in-hospital and 1-year stroke and death rate when stenting was used for lesions located in the carotid bifurcation and not just in the internal carotid artery. This might be related to the relatively lower conformability of closed-cell stents in a tortuous bifurcation anatomy.The next article is a multicenter study, written by Dr Jonathan Bath and colleagues, and is entitled "Endovascular interventions for claudication do not meet minimum standards for the Society for Vascular Surgery efficacy guidelines." 3 This VQI study investigated outcomes of endovascular treatment for intermittent claudication in 16,152 patients and compare them to standards established in the SVS guidelines. The main finding of the study was that only 32% the patients were free of recurrent claudication at 2 years. Recurrence was more likely with treatment of more than two arteries or in those who had atherectomy. The ...

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Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

Cited by 48 publications

References 24 publications

Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Retrograde Approach for Antegrade Inner Branches in a Precannulated Off-the-Shelf Multibranch Device

Journal of Vascular Surgery – May 2021 Audiovisual Summary

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